Revenue & Reimbursement

Healthcare reimbursement is payment that a hospital, diagnostic imaging facility, subspecialty department or healthcare providers receive for performing a service. This also includes individual radiologist or cardiologist reimbursement and billing and coding rules for submitting claims.

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RBMA Board member Kit Crancer outlines the key legislation in radiology to watch.

Pending radiology bills in Congress and predicting the Trump administration's impact on imaging

Kit Crancer, RBMA board member, speaks with Radiology Business about key legislative developments on the Hill that will affect the specialty. 

RSNA Board member Richard Heller, MD, explains issues with Medicare reinburements and the No Surprises Act and Congressional actions that may fix both.

Key Medicare reimbursement and No Surprises Act updates from RSNA 2024

Richard Heller III, MD, RSNA board member and senior VP of policy at Radiology Partners, offers an overview of policies in Congress that are directly impacting imaging.
 

Stock image of an illegal bribe.

Operations manager, doctors charged in $70M imaging kickback scheme

The scam took place over a period of seven years, resulting in Medicare being billed for more than $70 million in fraudulent claims for unnecessary scans. 

Georgia Lawrence, JD, with ASNC, explains how CMS uses hospital reported data to develop cardiac PET payment rates.

Understanding hospital billing for cardiac PET/CT

Significant fluctuations in PET and CT reimbursement rates have made it especially challenging to keep up with this complex topic. We spoke to an expert to learn more.

HeartFlow Plaque Analysis Example

New Category I CPT code issued for AI-enabled coronary plaque analysis software

The news comes just days after CMS confirmed these technologies would start receiving expanded Medicare coverage in November. HeartFlow and other AI vendors have already shared their excitement over the decision. 

Example of an automated artificial intelligence (AI) assessment of soft coronary plaque from a CT scan from the vendor Cleerly. The AI gives a very detailed report of all the plaque in all the coronary vessels. Some cardiology experts believe this may be the way of the future in screening patients for early coronary disease and monitoring the impact of prevention efforts such as statins to determine if more aggressive treatments are needed.

Medicare administrative contractors approve coverage of AI-enabled quantitative CT

Four of the seven Medicare Administrative Contractors (MACs) announced they will now cover artificial intelligence-enabled quantitative coronary tomography (AI-QCT) and coronary plaque analysis (AI-CPA). 

Time running out to comment on higher cardiac CT payments

Imaging experts have said the move could reshape the financial landscape for hospitals offering Cardiac CT services.

Ron Blankstein, MD, FACC, FASNC, MSCCT, FASPC, associate director, cardiovascular imaging program, director, cardiac computed tomography, Brigham and Women’s Hospital, and a professor of medicine and radiology, Harvard Medical School, explains why Medicare is proposing increased coronary computed tomography angiography (CCTA) payments to hospitals.

Higher payments for CCTA could bring considerable change to cardiology

Ron Blankstein, MD, explains how and why Medicare is proposing an increase to hospital payments for coronary CT angiography.

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Around the web

Health Imaging
Nearly $800,000 settlement offered to family of man who died during MRI exam

The patient, who was being cared for in the ICU, was not accompanied or monitored by nursing staff during his exam, despite being sedated.

Cardiovascular Business
Global shortage of nuclear imaging isotopes may be over

The nuclear imaging isotope shortage of molybdenum-99 may be over now that the sidelined reactor is restarting. ASNC's president says PET and new SPECT technologies helped cardiac imaging labs better weather the storm.

Cardiovascular Business
‘A huge win’: CMS significantly increases Medicare payments for cardiac CT

CMS has more than doubled the CCTA payment rate from $175 to $357.13. The move, expected to have a significant impact on the utilization of cardiac CT, received immediate praise from imaging specialists.