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. 

robot reviewing heart data

Medicare coverage expands again for AI-enabled coronary plaque assessments

Another MAC has agreed to cover the use of these advanced technologies to evaluate patients for signs of coronary artery disease. 

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). 

HeartFlow Plaque Analysis

CMS updates Medicare coverage for AI-powered coronary plaque assessments

The new policy goes into effect in November, improving Medicare coverage for a technology that has rapidly gained momentum in recent years.

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Around the web

Cardiovascular Business
Cardiology practices pay $17.7M to settle fraud allegations brought on by whistleblowers

A total of 16 cardiology practices from 12 states settled with the DOJ to resolve allegations they overbilled Medicare for imaging agents used to diagnose cardiovascular disease. 

Cardiovascular Business
Cardiology, radiology specialists debate CCTA’s rise as a go-to imaging modality for CAD

CCTA is being utilized more and more for the diagnosis and management of suspected coronary artery disease. An international group of specialists shared their perspective on this ongoing trend.

Cardiovascular Business
New AI program delivers rapid, accurate echo video assessments

The new technology shows early potential to make a significant impact on imaging workflows and patient care.