Medicare Compliance & Reimbursement

New standards, self-referral rules could stymie non-radiologists

In its March report to Congress, the Medicare Payment Advisory Commission will recommend  limits on physicians ordering and interpreting   diagnostic imaging services. Under current law, the  same physician can order an imaging test and perform and interpret the results of that test. Radiologists have called for a regulation that would bar the same doctor from ordering and interpreting an imaging scan so  physicians would have to send scans to qualified radiologists to interpret.

MedPAC will encourage the Centers for Medicare & Medicaid Services to study doctors' use of imaging services and to set up coding edits to reduce payments when a doctor orders multiple imaging tests on "contiguous body parts." Also, MedPAC will call on Congress to require standards for Medicare providers who perform diagnostic imaging services, including standards for non-physician staff, equipment and image quality. Also, Congress would set standards of training, education and experience for doctors interpreting imaging tests.

Expect Crackdown On Docs Ordering, Interpreting Tests Meanwhile, MedPAC will call for a change in the Stark physician self-referral law to prevent physicians from referring to imaging centers that lease equipment from companies that the physicians own. Doctors could still provide imaging services in their own offices under the "in-office ancillary exception."

When non-radiologists own imaging equipment in their office suites, "the equipment tends to be - and usually in my experience has been - of lower quality, [and] lower cost ... and they get reimbursed the same as a full-fledged imaging center," complained radiologist Ken Heithoff, speaking for the National Coalition for Quality Diagnostic Imaging Services.

Studies that supposedly show non-radiologists have a worse quality of imaging services or interpretation are inadequate and inconclusive, countered Camille Bonta with the American College of Cardiology. A study by Blue Cross-Blue Shield of Massachusetts showed the highest "failure rate" of imaging among chiropractors and podiatrists, not surgeons and specialty physicians, she noted.