CMS Kick-starting New Radiology Prior-authorization Policies on July 1, Imaging Advocates Warn With the calendar flipping over to July, new radiology prior-authorization policies are kickstarting this month, imaging advocates warned recently.
The changes apply to rad practices that provide interventional vein and vascular care in hospital outpatient facilities. Medicare Administrative Contractors started sending out letters about the shift last month, the Radiology Business Management Association noted in a Monday blog post.
With the switch, interventional radiologists must now obtain prior approval before billing CMS for eight imaging-guided procedures. Those include
destruction of a vein in the arm or leg using chemicals, lasers or radiofrequency.
The Centers for Medicare and Medicaid Services first finalized these new prior-authorization policies in 2019 as part of its 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule.
“Although the rule was published last year, the appearance of the letters may lead to questions from your practice’s interventional radiologists, especially since prior authorization is a hot button issue,” RBMA advised its members June 29. “It is important to note that CMS has not changed medical necessity and documentation requirements for these procedures.”
CMS noted that it hopes this process will help to control unnecessary increases in the volume of these imaging-based services, while also protecting the Medicare Trust Fund from improper payments. You can find the full list of procedures, with Current Procedural Terminology codes, here, and a sample letter from Medicare Administrative Contractors here.
To read more, go to Radiology Business.
Walgreens Testing Smaller Store Format: 8 Things to Know
Walgreens is testing a new type of store that cuts down on square footage and emphasizes the pharmacy. Internally, the pilot project is dubbed “Cooper,” according to CNBC.
Here are eight things to know:
To read more, go to Becker’s ASC Review.
340 Organizations Plead with Congress for Permanent Telehealth Reform
Letter signed by multiple stakeholders urges action before the COVID-19 public health emergency ends, and Americans fall off “telehealth cliff,” losing access to these services.
The coronavirus pandemic has ignited the need for permanent telehealth reform. While barriers to access virtual care were temporarily lifted by the government and private payers, the government waivers are set to expire when the public health emergency ends.
Yesterday, 340 organizations signed a letter urging Congressional leaders to make permanent changes that will enable Americans to continue to access telehealth services beyond the COVID-19 pandemic. Signatories include associations devoted to telehealth, connected health, virtual care, and information technology; health systems; and industry vendors.
The letter cites a significant uptick in the use of telehealth services:
“Taken as a whole,” the letter says, “these temporary policy changes have allowed 46% of Americans to replace a cancelled healthcare visit with a telehealth service during the pandemic.”
To read more, go to HealthLeaders Media.
Radiologists Must Become ‘Data Wranglers’ for a Front Seat in Healthcare’s Future
Radiology reports and images contain mounds of insightful data, and much of it could contribute significantly to improving patient outcomes if easily accessible through the electronic health record.
But that isn’t the case for many imaging departments. Instead, free-text reports are often radiologists’ main contribution to the EHR. And these writeups— largely unchanged since the early days of the profession—are not going to cut it in the team-oriented, data-driven healthcare delivery system of the future.
That’s according to a Friday morning presentation during SIIM’s virtual meeting, delivered, in part, by Tarik K. Alkasab, MD, PhD, service chief of informatics/IT & operations at Harvard Medical School. Radiology must close this “data gap,” he said, and include structured clinical exam information within system-wide data streams.
Alkasab pointed to measurement information such as lymph node size, nodule location and liver density, and clinical-categorization data like tumor and stroke volumes, liver stiffness and BI-RADS categories. Such insights would undoubtedly impact decision-making. The key, he added, is using “common data elements” to label values, so physicians across the enterprise can quickly access and understand the information.
And the ACR and RSNA already have such a resource in place with RadElement. The online site creates machine-readable values in radiology reports that are easily transferrable to the EHR, regardless of vendor.
In practice, imaging experts would enter these descriptors into a reporting module to illuminate their findings, which then would generate report text and, in some cases, appropriate recommendations.
This will only get easier as artificial intelligence continues to progress and will thrust radiologists into a more advisory role, one Alkasab describes as “data wranglers.”
To read more, go to Health Imaging.
CMS to Grant Hardship Relief for Radiologists in the 2020 Merit-Based Incentive Program
The Centers for Medicare and Medicaid Services recently announced that its proving hardship relief to radiologists and other clinicians participating in
the 2020 Merit-Based Incentive Program.
Providers who have been hit hard by the COVID-19 pandemic can now submit an Extreme and Uncontrollable Circumstances Application outlining their challenges. If approved, this would reweigh any or all performance categories for performance year 2020, the American College of Cardiology noted Thursday. Those seeking a reprieve must explain how the public health emergency has severely impacted their imaging practice.
ACC also noted that the federal government has added two new coronavirus-related improvement activities to the quality payment program. Rads and other docs can now obtain MIPS credit by participating in a COVID-19 clinical trial or caring for patients suffering from the disease and submitting their related data for future studies.
The biggest potential impact from this announcement could be a reduction in the pool of MIPS money available for payout incentives, noted Sandy Coffta, VP of client services for Healthcare Administrative Partners. “Practices who are struggling to meet the stricter 2020 MIPS requirements are likely to take advantage of this exception in order to avoid a penalty,” she told Radiology Business Friday. “If a significant number of lowperforming physicians or groups apply for and receive this exception, incentive payouts in 2022 will be less than anticipated.”
The American College of Radiology also highlighted the CMS change in an alert to its members posted Thursday. You can find further details about hardship exception, including the application, on the Quality Payment Program website here.
To read more, go to Radiology Business.
New $40.5M Research Center Dedicated to Mapping Alzheimer’s Disease
A new $40.5 million research center funded by the National Institute on Aging opened today and is focused on mapping the brains of patients with Alzheimer’s disease.
The collaborative center doesn’t yet have a name, but is headquartered at the Allen Institute, a Seattle-based nonprofit research organization. With five years of funding, scientists hope to determine how and where the disorder begins and identify new brain cells that are most vulnerable at the onset of the disease.
Lead investigator of the new initiative, Ed Lein, PhD, says their work will build off methods developed at the Allen Institute and work done through the National Institutes of Health BRAIN Initiative. The University of Washington Medicine and Kaiser Permanente Washington Health Research Institute will undertake additional projects.
“We’re trying to cure a disease of a complex system we fundamentally don’t understand,” added Lein, who leads the Allen Institute’s brain science division. “Historically, the field has focused on the amyloid hypothesis, but that hasn’t panned out for treatment. What’s really needed is to take a fresh look at the basic progression of the disease across the brain, and we now
have high-resolution cellular and molecular technologies in place to do just that.” To read more, go to Health Imaging.