Moran Report: 87% of Imaging Procedures Affected by DRA Cuts
National Provider Identifier: Prepare Now for May Deadline

Moran Report: 87% of Imaging Procedures Affected by DRA Cuts

Using Medicare claims data and 2006 patient rates from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (MPFS) and Hospital Outpatient Payment System (HOPPS) to make cross-site spending comparisons, a new report from The Moran Co, Arlington, Va, assesses the impact of the Deficit Reduction Act of 2005 (DRA) imaging cuts by procedure.

The report finds that 87% of procedures subject to cuts would be reimbursed at rates below what it costs physicians to provide the examination. For some procedures, Medicare would reimburse providers less than 20% of the cost of providing the service.

The following two charts illustrate the top 10 codes least and most affected by the DRA. MPFS payments fall short of OPPS payments by $579 million, or 34.2% on average, for the top 10 procedures not affected by the DRA cap. In considering the top 10 procedures most affected by the DRA, MPFS payments at 2006 rates were $725 million, or 36.8% higher, than would have been paid under OPPS methodology. The totals were based on volumes paid under the MPFS from 2004. Access the report in full via the Web sites of the American College of Radiology (ACR),, or the Access to Medical Imaging Coalition (AMIC),

National Provider Identifier: Prepare Now for May Deadline

By Cat Vasko

The compliance date for obtaining a National Provider Identifier (NPI) is May 23, 2007, but the Centers for Medicare and Medicaid Services (CMS), Baltimore, suggests that providers get their NPIs early. “Individual providers should apply now for an NPI,” recommends Susan A. Miller, chief operations officer and chief privacy officer at, Jacksonville, Fla. “Health care providers who participate in a group practice, or are organizational providers, should coordinate with their organization to determine the appropriate time for NPI application.”

The NPI is a Health Insurance Portability and Accountability Act (HIPAA) requirement; it will replace all other provider identifiers, including provider numbers assigned by payors and health plans, as well as unique provider identification numbers (UPIN). Intended to ease the administrative burden of managing the multiple identifiers necessary for electronic claims submission, the NPI is an important step toward standardizing this system. But Patricia Kroken of Healthcare Resource Providers, Albuquerque, NM, stresses that the interim could be rocky, with operational difficulties potentially leading to dips in cash flow.

The National Plan and Provider Enumeration System (NPPES), developed under a contract with CMS, will assign the NPI; NPPES also will compile, maintain, and update identifying and administrative databases. The Department of Health and Human Services estimates that 1,157,821 entities need to be assigned an NPI; the identifier will stand for the life of the provider except in cases of fraudulent use.

Kroken notes that the typical radiology practice will need to obtain NPI information for or from:

  • imaging centers, if they are separate legal entities;
  • individual radiologists;
  • health plans;
  • hospitals;
  • contracted imaging centers and/or physician offices that need to be identified on claims forms; and
  • referring physicians.

Radiology practice management vendors also need to be carefully examined. Although they probably will claim they are ready for the NPI, Kroken says, a number of potential issues cannot be addressed merely by amending fields to accept the 10-digit numbers.

It is important, therefore, to start the process early. “Gaining the NPI is only the first step toward the implementation date,” Miller says. Then, providers must proceed to share their NPIs and test them with payors, or face potentially destructive interruptions in cash flow. Miller recommends using the Web-based application system for the fastest turnaround time. Resources for practices include:

Cat Vasko is associate editor of  Axis Imaging News. For more information, contact .