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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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.

Dana Smetherman, MD, ACR CEO, explains AUC may be better than prior authorizations.

ACR CEO discusses solution to fight burdensome prior authorizations in medical imaging

Dana Smetherman, MD, MBA, outlines a possible remedy for the growing number of these roadblocks in the specialty. 

CMS may double Medicare payments for cardiac CT

The agency is gathering feedback on a proposal to double the amount hospitals are paid for coronary computed tomography angiography, with the comment period ending Sept. 9.

Dana H. Smetherman, MD, MPH, MBA, FACR, the new CEO of the American College of Radiology (ACR), explains some of the hot button issues in radiology and advocacy efforts led by the ACR.

New ACR CEO outlines key concerns for radiology

Dana Smetherman, MD, MBA, explains some of the hot button issues in imaging and key advocacy efforts being undertaken by the college. 

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Around the web

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.

Cardiovascular Business
GE HealthCare moves PET/CT scanner production to United States

The all-in-one Omni Legend PET/CT scanner is now being manufactured in a new production facility in Waukesha, Wisconsin.

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