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  Latest News

Briefing on Surprise Billing Legislation
On Sunday afternoon, the House Energy and Commerce (E&C) Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee announced they reached a bipartisan, bicameral agreement on legislation that addresses a number of healthcare issues. Most notably, the bill includes a long-sought agreement between the two Committees on how to design legislation that protects patients from unexpected out-of-network (OON) “surprise” medical bills as well as how the patient’s health plan should reimburse OON providers in surprise scenarios.
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Also see: section-by-section summary provided by committees
Federal Surprise Billing Legislation May Be Coming Soon
“Surprise” or out-of-network medical bills arise when a patient receives medical care at a hospital inside their insurance network but is later hit with an enormous bill because those providing the treatment were out-of-network. Patients are generally unaware and believe they are being covered, and these situations oftentimes cannot be avoided (e.g. emergency room services).
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CMS Releases New Information on Appropriate Use Criteria to MACs
The biggest question our community had going into 2020 was around the Educational and Operational Testing Period which lasts for the full calendar year. Specifically, we wanted to know exactly what CMS meant by their statement that "claims will not be denied for incorrect AUC information.".
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Revision to the Definition of Physician Supervision Requirements for Radiology Assistants
The Centers for Medicare & Medicaid Services (CMS) finalized a regulatory revision in the 2019 Medicare Physician Fee Schedule (MPFS) final rule, effective January 1, 2019, that changes supervision requirements for Radiology Assistants (RAs).
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The Final 2019 MPFS: What Radiology Providers Need to Know
On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released the 2019 Final Medicare Physician Fee Schedule (the Final Rule) which addresses changes to the Medicare physician fee schedule and other Medicare Part B policies. 
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CA's Breast Density Legislation Extended Through 2025
Legislation to extend California’s breast density reporting bill has been signed by California Gov. Jerry Brown, ensuring the law will remain in place through 2025. 
Read more at Radiology Business.

2019 HOPPS Proposed Rule Summary
The proposed rule for the 2019 Hospital Outpatient Prospective Payment System (OPPS) was released by CMS on July 25. This article highlights two aspects of particular interest to the AHRA community: 1) Updates to the Site Neutral Payment Policy; and 2) Cost Center Calculation Updates for MRI and CT. 
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2019 Proposed PFS: AUC Summary
On July 12, CMS released the proposed rule for the 2019 Physician Fee Schedule. Here are a few quick takeaways from the primary AUC section.
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AHRA CDSM/AUC Stakeholder Update
In February, 2018, AHRA brought together stakeholder groups with an interest or authority over how information will be generated by the Clinical Decision Support Mechanisms, coded and transmitted through the imaging operational system (i.e., ordering professional to imaging department to radiologist), and the placement of the CDSM code on the Medicare claim (both technical and professional).
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CMS Clarifies CR to DR Policy (Modifier FY)
CMS recently released their quarterly update of the Hospital Outpatient Prospective System and clarified their policy regarding the applicability of modifier FY when images were performed using both CR and DR technology (multiple views). Modifier FY is to be reported when CR technology is the only technology used to perform the imaging service. If an imaging service has both CR and DR views, then the payment adjustment does not apply and modifier FY does not need to be used. AHRA urged CMS to provide clarification on these types of scenarios and we are pleased to see that they have clarified the policy. Here is the relevant language from the quarterly update (emphasis added):

CMS notes that section 1833(t)(16)(F)(ii) refers to an imaging service that is an X-ray taken using computed radiography technology. Where the imaging service is comprised of multiple images that include both X-rays taken using computed radiography technology and images taken using digital radiography, CMS does not believe the payment reduction would apply to that service. Instead, the payment adjustment applies to an imaging service that is an X-ray taken using computed radiography technology where the X-ray taken using computed radiography technology is not combined with digital radiography in the same imaging service.

This “CR to DR” policy was created by the Consolidated Appropriations Act of 2016 and it reduces Medicare reimbursement for X-rays taken using computed radiography technology by 7% until 2022 and 10% thereafter. The intent is to incentivize a transition to digital radiography technology and save Medicare money. The Consolidated Appropriations Act of 2016 also reduced Medicare reimbursement for film X-rays by 20%. If you perform an X-ray with film, you must use modifier FX.

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