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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VIDEO: The importance of the Physician Practice Information Survey and its impact on radiology reimbursements

Linda Wilgus, CPA, CMPE, executive director and chief financial officer of Northwest Radiology Network and a past president of the Radiology Business Management Association (RBMA), explains the importance of the Physician Practice Information Survey CMS in calculating radiology reimbursements.

April 25, 2022
The ASNC is one of several medical imaging societies asking Congress to repeal the appropriate use criteria (AUC) criteria mandate. They say it poses issues for clinicians and is becoming outdated by changes in CMS payment systems. The AUC requirements call for documentation using CVMS authorized software in order to show advanced imaging such as nuclear and CT is justified, or else Medicare payments might be withheld.

American Society of Nuclear Cardiology urges Congress to speed prior authorizations, repeal AUC mandate 

Over the past few weeks, members of ASNC’s Health Policy Committee have held meetings with their members of Congress.

April 18, 2022
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Imaging industry advocate slams feds’ failure to address PET coverage gap in recent ruling

The Society for Nuclear Medicine & Molecular Imaging expressed "strong opposition" following CMS' decision, arguing there is no evidence to support limiting pay for such scans. 

April 11, 2022
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American College of Radiology, patient advocacy groups urge feds to fix CTC coverage gap

ACR and others have submitted a formal national coverage determination request, asking the agency to address payment gaps for virtual colonoscopies. 

April 7, 2022
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CMS delays start of Radiation Oncology Alternative Payment Model yet again

The mandatory bundled payment initiative was slated to kick off Jan. 1, 2023, following numerous delays, but will now launch on a to-be-determined date.

April 7, 2022
Medicare money payment physician. The CardioVascular Coalition and Society for Cardiovascular Angiography and Interventions have both issued new statements highlighting their issues with the 2024 MPFS proposed rule. 

S&P downgrades radiology provider Envision Healthcare, citing ongoing cash crunch

Analysts expect the Nashville, Tennessee-based physician firm's liquidity position to "meaningfully deteriorate" over the next year under its current operating structure. 

April 5, 2022
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Moody’s upgrades RadNet’s outlook to ‘positive’ amid full recovery from COVID-19, improved financials

Analysts highlighted the imaging giant's “strong” competitive position, multifaceted revenue streams through the delivery of various imaging modalities, and payer diversity. 

April 4, 2022
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DBT coverage mandates increase use but have no impact on patients’ out-of-pocket costs

More than a dozen states have required private payers to cover digital breast tomosynthesis, producing a $39 decrease in average price for the exam. 

March 28, 2022

Around the web

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

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

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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