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Most radiology practices and imaging centers choose to outsource medical billing and coding to stay up-to-date on all the regulations and individual payer changes. This allows them to submit claims accurately and ensure proper reimbursement.

Several factors have fuelled the demand and reimbursement for radiology services in recent years: increasing geriatric population and growing incidence of various diseases, technological developments in diagnostic imaging modalities, increasing preference for minimally invasive treatments, and government funding for modernization of imaging facilities. However, a recent study published in the April edition of Health Affairs suggests that these trends have been reversed and that medical imaging use in the U.S. has taken a tumble after years of extensive growth. Examining trends over the period 2000-2014, the study found that cuts in federal reimbursement and new coding arrangements have affected hiring decisions and equipment purchases, and curtailed access to the technology.

Imaging modalities commonly used by radiologists are: X-rays, CT scans, nuclear medicine positron emission tomography (PET), MRI scans, and ultrasound. The new study notes that imaging saw rapid growth between 2001 and 2008 and new technologies reduced time needed for diagnosis and patient care. While echocardiography use increased 42% between 2001 and 2008, it declined 61% during 2008-2009 and continued to fall until 2014. The use of other imaging modalities such as nuclear and CT imaging also declined during the same period.

According to the researchers, the reasons for the decline in imaging use since the 2000s are:

  • Changes in federal policy: The Deficit Reduction Act of 2005 took effect in 2007, setting off imaging reimbursement cuts.
  • New coding arrangements: Beginning in 2009, CMS created a new code that incorporated three procedures which were earlier billed using three distinct codes. That is, prior to 2009, providers performing a transthoracic echocardiogram usually also performed “add-on” spectral Doppler and color flow Doppler studies. Since 2009, CMS bundled three codes into the single new one and required that providers use the new code whenever the three procedures were performed together. The lead author of the study notes that these payment policies have achieved the “desired effect” of reducing imaging use.
  • Cuts in reimbursements by payers: After the 2000s, insurance companies restricted reimbursements which led to a rapid decline in imaging use as providers could not purchase as much imaging equipment as they did before. The reimbursement cuts also forced them to reconsider their decisions to hire additional radiologists.
  • Changes in healthcare culture: The increasing concern among physicians about radiation exposure also led to reduced imaging use. Providers adhered to practice guidelines more closely. Radiology management companies that tie up with insurers to preauthorize advanced imaging requests, placed restrictions between testing orders and actual tests.
  • Cost-cutting policies: In recent years, accountable care organizations and bundled payments have led providers to focus more on cutting costs. Increasing plan deductibles has also slowed cost growth by encouraging consumers to reduce use.

The authors conclude that if there are no significant changes in code bundling and imaging rates, radiology reimbursement rates will remain the same in the near future.

It is obvious that the business of radiology has become increasingly complex with growing regulatory demands and decreasing revenue for hospitals and physicians. Ensuring proper CPT and ICD-10 code usage is necessary to meet quality improvement requirements and get paid. In this scenario, outsourcing radiology medical billing is a cost-effective option to meet industry regulations and ensure optimal reimbursement.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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