Local, State, Federal

DRA: Where Do We Go From Here?
Radiology Coding Books Offer Assistance to Professionals
Quick Policy Hits
Medicare Posts Physician and Hospital Outpatient Information

DRA: Where Do We Go From Here?

By Cat Vasko

Now that the Deficit Reduction Act of 2005 (DRA) has passed with the controversial Medicare imaging reimbursement cuts intact, what is the next step? Axis Imaging News spoke with Tim Trysla, executive director of the Access to Medicare Imaging Coalition (AMIC), about reintroducing legislation, revitalizing grassroots support, and more.

IE: What does AMIC have planned for 2007?

Tim Trysla, Access to Medicare Imaging Coalition.

Trysla: We’re going to be laying out a whole new agenda, which will culminate in a couple of different things. Number one is an impact analysis, so that providers understand what modalities are going to be cut and how this policy actually works; that’s something we’ve already undertaken, so we’ll hopefully have that up on the Web site soon. Number two is obviously a re-introduction of our legislation, and we’re working with members of the Senate and the House to do that.

IE: Will AMIC try for the 2-year moratorium again, or look to repeal the cuts entirely?

Trysla: I’m meeting with my steering committee soon, and then we’re meeting with members of Congress. But simply, we’re committed to having members of Congress revisit this policy. I’m assuming we’ll move forward with our 2-year moratorium with an analysis, but I’m not the final decision-maker. It’s going to be our steering committee, and then we’ll go to work with Congress.

IE: But the aim is to reintroduce legislation to the same effect?

Trysla: Yes.

IE: Is AMIC still recruiting other organizations to be members?

Trysla: We are. We’re going to work with grassroots [organizations]. And one of the biggest concerns that we’ve heard from members of Congress is that because the cuts hadn’t gone in place yet, there wasn’t a clear impact on access. We think there’s going to be a huge outcry from the public as they come to understand how these policies work. To some extent, this policy was adopted in the middle of the night. It wasn’t in the Senate-passed version; it was adopted in a conference report and slipped in, and two thirds of the Medicare cuts came out of this sector. There’s no real good footing for this policy other than the fact that Congress was looking for additional savings. That savings is, unfortunately, going to be borne on the backs of patients because of limited access to advanced technologies that identify some of the most catastrophic diseases, like cancer.

IE: Will AMIC work with the same House co-sponsors?

Trysla: It’s likely. We’ve had a great response from our co-sponsors in the past, but again, I defer to the members of Congress who’ve stood up for us in the past. It’s too premature to say, because we’re meeting with members of Congress as they return. We’ll know more after we have a chance to talk to the Congressmen and women who’ve endorsed our legislation in the past. Congress may go for a repeal, or they may go for a 2-year moratorium; it just depends on what’s doable. I think from a PR standpoint, reintroducing the same legislation seems to make a lot of sense, so there’s not a new re-education. But that’s just my opinion.

Radiology Coding Books Offer Assistance to Professionals

Five texts offered on an annual basis by MedLearn Inc, St Paul, Minn, cover every facet of the imaging industry—from CT and MR to ultrasound and nuclear medicine. Monthly e-newsletters provide crucial updates, and books can be bought in 3-year packages at a discounted rate. The Interventional Radiology Coder—originally developed by Mike Rogge, founder and president of MedLearn—was the company’s first publication and remains its best seller; the book supplements its list of CPT codes for more than 400 interventional radiology procedures with easy-to-read diagrams, charts, and other visual aids. Additional texts include:

  • Nuclear Medicine Coder, which matches CPT codes and current Medicare payment rates to an array of diagnostic and therapeutic procedures, as well as offers billing tips by body section;
  • CT/MR Coder, with billing guidance for all codes covering CT, CT angiography, MRI, and MR angiography procedures, including both the professional and technical components;
  • Ultrasound Coder, offering at-a-glance listings of CPT codes and billing tips for each diagnostic ultrasound procedure; and
  • Mammography Coder, providing coding, billing, and modifier tips, as well as comprehensive tables of relative value units and appendices of mammography-related regulatory documents.

To learn more about MedLearn’s range of radiology coding resources, visit www.medlearn.com.

—C. Vasko

Quick Policy Hits

Maryland Acts Against MRI Self-Referral
A new Declaratory Ruling on the part of the Maryland Board of Physicians speaks up against MRI self-referral, showing that nonradiologist physicians understand the issue and can be recruited to take a stand against it. The Ruling arose out of two formal petitions filed separately—one by CareFirst BlueCross BlueShield, and the other by The Injured Workers’ Insurance Fund. Both ask the Board to rule on the propriety of referrals made by physicians for MRI scans when said physicians have a financial interest in the performance of the scan.

The Ruling states: “A referral by an orthopedic physician for an MRI to be performed on or by an MRI machine owned or leased by the orthopedic practice, insofar as that referral meets the criteria set out in the General Fact Pattern, is an illegal self-referral within the meaning of the Maryland Self Referral Law. The exceptions set out in 1-302 (d)(2), (d)(3), or (d)(4), argued in this case, do not exempt these tests from the general prohibition of the Maryland Self Referral Law.”

This Ruling is being enforced now. To view the Ruling in full, visit www.mbp.state.md.us/index.html.

State False Claims Under the DRA
Section 6031 of the Deficit Reduction Act of 2005 (DRA) mandates a reward for enacting a state false claims law, provided it mirrors the federal False Claims Act (FCA). But the Department of Health and Human Services Office of Inspector General (OIG) is evaluating whether the state laws match the FCA closely enough, and seven states (out of the 10 that have applied thus far) have been denied the bonus.

To qualify, OIG says state false claim laws must meet the following requirements:

  1. establish liability to the state for false or fraudulent claims described in the FCA with respect to any expenditures related to State Medicaid Plans described in section 1903(a) of the Act;
  2. contain provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as those described in the FCA;
  3. contain a requirement for filing an action under seal for 60 days with review by the State Attorney General; and/or
  4. contain a civil penalty that is not less than the amount of the civil penalty authorized under the FCA.

OIG has turned down California, Florida, Louisiana, Indiana, Michigan, Nevada, and Texas. It has approved Illinois, Massachusetts, and Tennessee.

—C. Vasko

Medicare Posts Physician and Hospital Outpatient Information


Range of payment rates


$203 to $225




$224 to $256


$202 to $226


$243 to $313


$228 to $261


$259 to $286


$231 to $253


$217 to $244


$208 to $265

Table 1. Payment Rates for Prostate Needle Biopsy, Any Approach (CPT 55700), Across 10 Markets.

In concert with the growing trend toward health care price transparency, the Centers for Medicare and Medicaid Services (CMS) is making Medicare payment information available to the public. The information offered includes data for common services provided in physicians’ offices as well as services performed in hospital outpatient departments; it complements the inpatient hospital and ambulatory surgery center data already accessible via the CMS Web site (www.cms.hhs.gov).

“The new information on physicians and hospital outpatient departments adds to the information that people can use to make better decisions on their care,” CMS Acting Administrator Leslie Norwalk said in a statement. “In all areas of care, we are supporting collaborative efforts that are providing unprecedented information to help people get the best quality care for the best price.”

In a Presidential Executive Order dated August 22, 2006, President Bush mandated that more data be made available to the American public regarding health care pricing. The new information posted online by CMS allows consumers to compare the costs and procedures, which may vary by location. The data includes payment rates for more than 70 physician services rendered in nonoffice settings as well as 19 services usually performed in a physician’s office; outpatient data also will be based on commonly performed procedures.

Some private insurers are following suit, such as athenahealth in Texas and Aetna in some markets.

“These new data build on the President’s commitment to making more quality and price information available,” Mike Leavitt, Secretary of the Department of Health and Human Services, said in a statement. “By posting data about federal health care programs like Medicare, we are on our way to giving Americans the information they need to make informed health care decisions.”

—C. Vasko