Radiology Coding Alert

Radiology coders wonder what ACO structure will mean for the future.

The U.S. has been buzzing about the United States Supreme Court's recent decision to uphold the constitutionality of the Affordable Care Act (ACA). In that decision, the Supreme Court ruled that the requirement that individuals must have health care coverage or face a penalty was an allowable tax (rather than a penalty). But the Court decided the federal government couldn't require states to expand existing Medicaid programs by proposing to disqualify noncompliant states from Medicaid funding.

Many coders are taking the "wait and see" approach regarding how the law will affect their day to day job functions, but there are a few areas to keep on your radar.

Preventive services: If patients "have a new health insurance plan or insurance policy beginning on or after September 23, 2010," certain preventive services must be covered when delivered by a network provider. For these services, the patient is not responsible for a copayment, co-insurance, or meeting the deductible. According to the preventive services fact sheet at www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html, some of the covered services your radiology practice may see include:

• One-time abdominal aortic aneurysm screening for certain men with a history of smoking
• Mammography screenings every 1 to 2 years for women over 40
• Osteoporosis screening for women over age 60 if they have certain risk factors.

ACOs: The ACA creates voluntary Accountable Care Organizations (ACOs). An ACO is a group of providers, hospitals, and others who coordinate to improve a Medicare patient's care. The coordination aspect of the ACOs has left some radiology coders speculating how ordering habits and rules will be affected. To learn more about ACOs, see JACR's March 2011 article, "A Radiologist's Primer on Accountable Care Organizations" (www.jacr.org/article/S1546-1440%2810%2900441-2/fulltext) and the ACR White Paper "Strategies for Radiologists in the Era of Health Care Reform and Accountable Care Organizations: A Report From the ACR Future Trends Committee" (www.acr.org/~/media/ACR/Documents/PDF/Economics/Medicare/ACO/ACR_ACO_White_Paper.pdf).

Equipment utilization, MPPR: You're probably well acquainted with two ACA-related reimbursement provisions. One bases payment for certain imaging services on a 75-percent equipment utilization assumption rate. This affects technical component (TC) reimbursement by assuming the equipment cost is spread over a large number of services. The multiple procedure payment reduction (MPPR) that reduces payment for certain imaging services when performed at the same session also remains in place. This multiple procedure reimbursement reduction is one of the bigger issues for radiologists, notes Terry A. Fletcher, BS, CPC, CCS-P, CCS, CEMC, CCC, CMSCS, CMC, of Terry Fletcher Consulting in Laguna Beach, Calif.