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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PHOTO GALLERY from AMA House of Delegates 2022 meeting

Here are images from the American Medical Association (AMA) 2022 House of Delegates (HOD) meeting in Chicago, June 10-15. This was the first time the HOD met in two and a half years because of the COVID-19 pandemic.

June 15, 2022
How radiology should prepare for AUC clinical decision support reporting requirements. CMS to require AUC CDS January 1, 2023.

How radiology should prepare for AUC clinical decision support reporting requirements

An overview for the coming January 2023 mandate to use clinical decision support for all advanced imaging orders.

May 10, 2022
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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 long legal saga of Richard Paulus, a Kentucky cardiologist accused of performing unnecessary cardiac procedures, appears to still be going strong in 2022 and might be reviewed by the Supreme Court. The New York state radiologist is facing 36 misdemeanor counts for secret sexual recording without consent, according to a story in the Boston Herald.

Cardiologist’s legal fight against fraud conviction may be heard by Supreme Court

Kentucky cardiologist Richard Paulus was first found guilty back in October 2016, but he was granted a new trial in 2021. 

April 20, 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 They say it poses issues for clinicians and is becoming outdated by changes in CMS payment systems.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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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

Around the web

The recall includes specific lots of five different medical devices used to treat stroke and other neurovascular diseases.

The agency is urging healthcare providers to transition away from these devices and seek out alternatives. It is even working with other manufacturers to try and get similar products on the market as quickly as possible. 

Jeffrey Kuvin, MD, one of the leading voices behind efforts to create a new Board of Cardiovascular Medicine, spoke with Cardiovascular Business about where things stand today.

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