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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Kumar Aditya, director, information technology, Atlantic Health System, explains how the system automated more than 60% of its radiology prior authorization workflow.

How Atlantic Health automated its radiology prior authorization workflow

Director of IT Kumar Aditya explains how the New Jersey hospital system automated more than 60% of its radiology prior authorization workflow.

October 3, 2023
Top 1% of physicians account for 17.5% of Medicare pie

Private-payer billings not radiology’s revenue category to lead

Going by claims submitted to commercial insurers, radiology ranks 15th out of 18 physician specialties. 

April 3, 2023
The integration of artificial intelligence (AI) into radiology PACS and enterprise imaging systems has become a big topic of discussion with IT vendors over the past couple years. This has become a bigger question from hospitals and radiology groups as there are now about 400 radiology related AI algorithms that have U.S. Food and Drug Administration (FDA) clearance. Amy Thompson, a senior analyst at Signify Research, is monitoring radiology AI trends. Photo by Dave Fornell

Trends in the adoption and integration of AI into radiology workflows

Amy Thompson, a senior analyst at Signify Research, explains why AI adoption has been slow in radiology, common barriers and trends in the market.

February 17, 2023
Radiology Imaging

VIDEO: Impact of the 2023 Medicare cuts on radiology

Ed Gaines, JD, vice president of regulatory affairs and industry liaison, Zotec Partners, discussed the impact of the 2023 Medicare Fee Schedule on radiology at RSNA 2022 in Chicago last week. RSNA and several other medical societies say the cuts are not sustainable.

December 8, 2022
Ed Gaines, JD, CCP, vice president of regulatory affairs and industry liaison, Zotec Partners, discusses the No Surprises Act on radiology at the Radiological Society of North America (RSNA) 2022 meeting. Gaines works with RSNA on billing and Medicare issues and spoke in sessions at the RSNA 2022 meeting. Insurance companies have weaponized the No Surprises Act in an effort to cut their costs, he said.

VIDEO: Insurance companies have weaponized the No Surprises Act, may impact patient care

Ed Gaines, JD, CCP, vice president of regulatory affairs and industry liaison, Zotec Partners, discusses the impact of the No Surprises Act on healthcare and medical imaging at the RSNA 2022 meeting

December 7, 2022
Physicians are now bracing for payment cuts after the Centers for Medicare and Medicaid Services (CMS) published its final rule for the 2023 Physician Fee Schedule.

Providers face ‘ominous reality’ of payment cuts as CMS finalizes 2023 Physician Fee Schedule

Physicians are now bracing for payment cuts after the Centers for Medicare and Medicaid Services (CMS) published its final rule for the 2023 Physician Fee Schedule.

November 2, 2022
Example of the four types of breast tissue density. The density of fibroglandular tissue inside the breast impacts the ability to easily see cancers. Cancers are very easy to spot in fatty breasts, but are almost impossible to find in extremely dense breasts. These examples show craniocaudal mammogram findings characterized as almost entirely fatty (far left), scattered areas of fibroglandular density (second from left), heterogeneously dense (second from right), and extremely dense (far right). RSNA

Breast density notification laws blanket 90% of U.S. women, yet still no national reporting standard is at hand. Why is that?

Dense breast experts Wendie Berg, MD, and JoAnn Pushkin, executive director of DenseBreast-info Inc., explain the current status of breast density patient inform laws, reimbursement and new technologies to aid cancer detection. 

October 6, 2022
AMA analysis of Medicare Trustee data shows Medicare updates compared to inflation 2001-2021.

More than 100 medical societies push Congress to end destructive cycle of annual Medicare cuts

More than 120 medical societies have joined the AMA in a letter urging congressional leaders to enact long-term solutions to the systemic problems in the Medicare physician payment system and to address cuts that are going into effect in 2023.

September 26, 2022
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Around the web

Cardiovascular Business
Medicare drops AUC requirement for advanced imaging, ASNC celebrates

"This was an unneeded burden, which was solely adding to the administrative hassles of medicine," said American Society of Nuclear Cardiology President Larry Phillips.

Cardiovascular Business
Cardiology, radiology groups urge insurance provider to rethink imaging policy

SCAI and four other major healthcare organizations signed a joint letter in support of intravascular ultrasound. 

Cardiovascular Business
Radiology AI company gains FDA clearance for new CT offerings focused on PE, stroke

The newly approved AI models are designed to improve the detection of pulmonary embolisms and strokes in patients who undergo CT scans.

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