Radiology Coding Alert

News You Can Use:

Prepare Now for a Possible 35 Percent Cut in MRI Pay

Published on Wed Apr 19, 2006

Plus: A new MQSA file will help carriers deny terminated-facility claims

Don't get caught off guard. CMS has two important data-related changes you need to know and a fee change you can't afford to miss:

1. Steep Cuts in Store for Imaging Codes: CMS plans to increase the discount for multiple imaging scans on contiguous body parts from 25 to 50 percent next year and reduce the technical component of many codes in line with the Hospital Outpatient Prospective Payment System (HOPPS) levels. Every managed-care plan that can imitate these imaging cuts probably will, says Thomas Powell, a senior consultant with Healthcare Administrative Partners in Media, Pa.

Action plan: If your practice performs a lot of CTs or MRIs, alert your practice that it's time to assess the cost of providing imaging scans in the office, says consultant Rebecca Massey with Gates Moore & Co. in Atlanta. You won't know whether you can afford to keep doing imaging scans in the office unless you understand your costs, she adds.

2. 'Medlearn Matters' Becomes 'MLN Matters': Not long after CMS announced that its Medlearn Matters articles would temporarily be referred to as MLN Matters articles--to avoid confusion with the company MedLearn--the change became official. CMS claims the new name more closely associates the articles with the Medicare Learning Network, Medicare Fee-for-Service providers' official information source.

Action plan: Edit your Medicare Internet bookmarks yet again. Change your Medlearn Matters link to the MLN Matters link, www.cms.hhs.gov/MLNMattersArticles.

You can find more information in the MLN Matters article on the new name, available online at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0620.pdf.

3. CMS Will Alert Carriers to Terminated Mammography Centers: Effective July 1, CMS will fill a new Mammography Quality Standards Act (MQSA) file with information on terminated facilities. The file will show the termination date, so carriers will pay claims for services performed before that date and deny them for later services.

Action plan: Read up on the information your carrier received--instructing them to upload the file weekly to ensure they pay you properly--at www.cms.hhs.gov/Transmittals/downloads/R828CP.pdf (Transmittal 828, CR 4303). Find the related MLN article at www.cms.hhs.gov/MLNMattersArticles/downloads/MM4303.pdf.