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Maximizing Reimbursement
Acting CMS Head Will Promote Agency Transparency

Maximizing Reimbursement

Recent data compiled by a Radiology Business Management Association (RBMA) survey shows that almost 90% of respondents have experienced reductions in their technical component (TC) payments for office-based imaging from payors other than Medicare. With the bottom line more important than ever in the post-DRA era, how can you maximize reimbursement? Julie Kaffenberger of Radiology Business Solutions, Flint, Mich, answers a few of our questions.

IE: What are some of the factors currently affecting reimbursement?

Kaffenberger: It really all comes down to Medicare. A significant portion of imaging is performed on the older population, making Medicare your top payor. Most of the other insurance companies will eventually follow what Medicare does.

IE: Is there a significant lag between when Medicare adopts a policy and when other payors follow suit?

Kaffenberger: Yes, but there’s no pattern. And not all payors follow Medicare’s lead. Some actually carry changes further. Contracts with other commercial carriers pay a percentage of Medicare.

IE: How have recent changes to Medicare impacted reimbursement?

Kaffenberger: They’ve lowered it. The first cut was for contiguous body parts, by 50%. The second item that affected reimbursement was for non-hospital-owned imaging centers. There was a major cut to CT and MRI technical reimbursement, which started this year. MR took the largest hit, and CT was the second largest. Those cuts ranged from 20% to 30%. It’s our belief they’ve done this because so many nonradiologists now have imaging in their offices. It’s a way to curb self-referral. And CT and MR are the two heaviest hitters in terms of reimbursement, as well as the modalities that are the most competitive.

IE: What technologies offer the highest TC rates?

Kaffenberger: PET, CT, and MRI. So the reimbursement cuts obviously affect the number of studies you need to perform to reach your break-even point or to have any return on your investment. The clinics are definitely feeling the aftereffects.

—Cat Vasko

Acting CMS Head Will Promote Agency Transparency

One week after being appointed by President George W. Bush as acting administrator for the Centers for Medicare and Medicaid Services (CMS), Kerry Weems told reporters at a September 12 press briefing that he plans to make CMS’s operations and decision-making processes more open to the public. This will include posting corrective-action measures between CMS and Medicare Advantage plans publicly on the CMS Web site.

“We’re going to try and do our business in daylight. I mean that literally and figuratively,” Weems said, according to The Hill.

In August, CMS was criticized for issuing a late-Friday release detailing strict expansion limitations for the New York State Children’s Health Insurance Program (SCHIP). Weems admitted that the agency could have done a better job of distributing that information. As evidence of improvement, he pointed out that the September announcement that the SCHIP expansion proposal had not been approved was issued early in the business day.

“That happened in the morning, in daylight. It was not a cocktail-hour press release. We are going to try to end those,” he said, according to The Hill.

According to Modern Healthcare, Weems said he will continue to support information-technology and quality initiatives, as well as report to Congress on value-based purchases in hospitals.

In May, Weems was nominated for the CMS administrator position by President Bush as a successor for Mark McClellan, who left the post in September 2006. Although a confirmation hearing was held in July, Weems’ confirmation is still pending approval from the Senate.

—Ann H. Carlson