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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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.

Erin R. Stevens, CNMT, NCT, director of nuclear medicine at Oregon Heart Center, said training physicians for what is needed in cardiac PET documentation is key for preventing issues with prior authorizations. ASNC photo

Good documentation is the key to cardiac PET prior authorizations

Knowing what, exactly, is needed in cardiac PET documentation is one of the best ways to limit prior authorization issues.

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.

CMS could increase CCTA payments—the American College of Cardiology wants to help

CMS wants feedback after proposing a significant update to CCTA reimbursement payments. The American College of Cardiology, a longtime champion for improved cardiac CT payments, is now helping its members make their voices heard.

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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
FDA clears AI tool that flags signs of heart disease in chest CT scans

The newly cleared offering, AutoChamber, was designed with opportunistic screening in mind. It can evaluate many different kinds of CT images, including those originally gathered to screen patients for lung cancer. 

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