Radiology Digest – August 8, 2023

August 15, 2023

Radiology Digest: News from the week of August 8, 2023.
Your Patient’s Medicare Beneficiary Identifier (MBI) May Change

CMS sent letters to people with Medicare who may have been affected by a recent data breach. CMS is mailing approximately 47,000 new Medicare cards with a new MBI to those affected. Learn what to do if your patient’s MBI changes. 

Ask your patient for their new Medicare card if you get “invalid member ID” when checking Medicare eligibility. Access your Medicare Administrative Contractor’s secure internet portal to use the MBI look-up tool if your patient didn’t get a new Medicare card yet.

To read more, go to

RBMA, ACR, RadNet and Rayus Radiology Urge CMS to Fix ‘Burdensome’ Reporting Requirement

By Marty Stempniak | August 2, 2023 | Included in Radiology Digest – August 8, 2023

Two professional associations representing radiology business interests and two outpatient imaging providers are asking the Centers for Medicare & Medicaid Services to fix what they say is an overly burdensome reporting requirement.

ACR, the Radiology Business Management Association, RadNet Inc. and Rayus voiced their concerns in a July 18 letter to CMS’ Hospital & Ambulatory Policy Group. They want the federal agency to waive the modifier reporting obligation in Medicare Part B tied to separately payable imaging contrast agents and radiopharmaceuticals.

“These requirements add a significant amount of additional time, resource, and administrative costs to providers, with no additional benefit to CMS,” the four organizations wrote to Laura Kennedy, PharmD, a health insurance specialist in the Division of Ambulatory Services.

The Infrastructure Investment and Jobs Act mandates that manufacturers provide a refund to CMS for any unused portions of drugs that come in single-use packaging. However, the rule does not pertain to radiopharmaceutical or imaging agents, the four organizations emphasized. The 2023 Medicare Physician Fee Schedule further outlined that providers should use one of two modifiers to clarify such scenarios— “JW” for discarded amounts or “JZ” to attest that there weren’t any leftovers.

Given the volume of studies affected by the change, ACR et al. are dismayed by the enormity of the undertaking. Each year, providers serve Medicare patients with more than 3 million enhanced imaging studies and more than 1.5 million diagnostic nuclear medicine exams involving radiopharmaceuticals.

Performing exams under the new mandate would call for updated workflows and forms, among other changes.

What’s more, the agents in question are often delivered on demand in premeasured doses, leaving nothing to report.

“We are concerned that the JZ modifier may result in billing errors, inadvertent claim denials, and slow claims processing, not only for providers but also for CMS,” the groups wrote. “In particular, coordination of care with Medicare supplement plans and Medicare as a secondary payer could be problematic as these payers are slower to adopt new modifiers.”

ACR, RBMA, RadNet and Rayus are asking CMS to waive the requirement for these drugs. They’re also urging the agency to pause the July 1 launch and Oct. 1 claims denial dates as these issues are sorted.

You can read the full letter on RBMA’s website (membership sign-in required).
To read more, go to Radiology Business.

35% of Medicaid Enrollees Say Their Health Plan Hasn’t Reached Out About Redeterminations: Survey

By Jakob Emerson | August 2, 2023 | Included in Radiology Digest – August 8, 2023

A large number of Medicaid enrollees, especially seniors, say their health plan has not reached out about how to renew coverage amid redeterminations, according to a new survey.

The survey was conducted by The Harris Poll on behalf of digital engagement platform Icario from July 18 to 20. The results were published July 31 and include responses from 957 Medicaid enrollees over 18.

Among all respondents, 35 percent said their health plan has not reached out about renewing coverage, and 55 percent of enrollees 65 and older said the same.

Among those that have heard from their health plan, 93 percent said they received appropriate information and the resources needed to complete the renewal process.

As of July 27, at least 3.79 million people have been disenrolled from Medicaid through the redeterminations process, according to KFF. Of those disenrolled, 73 percent are due to procedural reasons, rather than being determined ineligible for the program. 

To read more, go to Becker’s Payer Issues.

Amazon Bets Big on Virtual Care, Unveils Nationwide Telehealth Service Through Its Website, Mobile App

By Heather Landi | August 1, 2023 | Included in Radiology Digest – August 8, 2023

Amazon Clinic is expanding to all 50 states, including nationwide telehealth services to offer access to clinicians through its website and mobile app.

The online retail giant unveiled Amazon Clinic back in November as a virtual medical clinic to provide care for 35 common health concerns like urinary tract infection, pink eye, and acid reflux. Launched as a message-based virtual consultation service, Amazon Clinic connects consumers with licensed clinicians who can diagnose, treat and prescribe medication for a range of common health and lifestyle conditions.

The service was available in 34 states and has now been expanded nationwide and to Washington, D.C., along with the addition of video visits with providers on and the mobile app, the company announced in a blog post on Tuesday.

Amazon Clinic is currently cash pay and does not yet accept insurance, the company said. 

Nworah Ayogu, M.D., chief medical officer and general manager at Amazon Clinic, said the virtual health services help customers get the care and medications they need in the way that is most convenient for them.

“As a doctor, I’ve seen firsthand that patients want to be healthy but lack the time, tools, or resources to effectively manage their care. Amazon provides multiple health services to provide the choice, convenience, and continuity of care customers need when it comes to their health. Amazon Clinic removes barriers by helping customers treat their everyday health concerns wherever they are, at any time of day. And they can see the cost before they start the visit,” Ayogu wrote in the blog post.

The expanded service had been anticipated but was reportedly delayed due to lawmakers’ concerns about the company’s privacy practices, Politico reported back in June.  Senators Peter Welch, D-Vermont, and Elizabeth Warren, D-Massachusetts sent a letter to Amazon executives inquiring about patient health data privacy and expressed concerns that the platform’s new healthcare service is putting users’ private health data at risk, Politico reported, citing an email source.

To read more, go to Fierce Healthcare.

Lawmakers Propose ‘Gold Card’ Program that Exempts Physicians from Prior Authorizations Requirements

Marty Stempniak | July 31, 2023 | Included in Radiology Digest – August 8, 2023

Bipartisan House lawmakers have proposed launching a program exempting certain physicians from prior authorization requirements spelled out by Medicare Advantage plans.

The Gold Card Act of 2023 would shield doctors for one turn of the calendar, provided they had at least 90% of such PA requests approved in the prior year. It also would require plans to notify physicians if they qualify for the program no later than 30 days before the start of the next plan year.

Insurers typically use prior authorization to control utilization of healthcare services, but the practice is prone to abuse. Patients recently sued Cigna, alleging its program shirks the law by denying claims in bulk. Radiology faces the heaviest burden from prior authorization in Medicare Advantage, behind only radiation oncology and cardiology, a recent JAMA Health Forum analysis found.

“This commonsense bill will pass at the federal level what many states, including Texas, have already enacted,” Rep. Vicente Gonzalez, D-Texas, who sponsored the bill alongside Rep. Michael Burgess, MD, R-Texas, said July 31. “Bureaucratic red tape should not hinder patients’ ability to receive attention or our medical professionals’ ability to perform preventative or even life-saving care.”

In addition, the Gold Card Act would allow Medicare Advantage plans to revoke providers’ premier status if they fall below the 90% threshold. Physicians would have the ability to appeal these revocations if they believe insurers reached them erroneously. It also would require the HHS secretary to issue a rule on the use of PA by Medicare Advantage carriers “to ensure continuity of care” for those transitioning between plans.

The bill has drawn support from provider groups including the Texas Medical Association and national associations representing orthopedic surgeons, emergency physicians, dermatologists, neurological surgeons and ophthalmologists. The legislation does not specifically call out imaging or other services.

The Medical Group Management Association said Monday that radiologists, along with others who order imaging, stand to benefit from a gold card program like the one outlined.

“Year after year, medical practices identify prior authorization requirements as the most challenging and burdensome obstacle to delivering high-quality patient care,” Anders Gilberg, senior VP of government affairs for the MGMA, which represents more than 15,000 physician groups across radiology and other specialties, said in writing. MGMA supports the Gold Card Act of 2023 as “a critical step toward much-needed reform,” he added, saying the legislation would allow physician practices to “focus resources on patient care.”

Burgess previously proposed the same legislation in June 2022, but it failed to find passage.

To read more, go to Radiology Business.

CMS will Test APM for Medicare Beneficiaries with Dementia, Caregivers

CMS has announced plans to test an alternative payment model (APM) to support Medicare beneficiaries with dementia and their unpaid caregivers.

The Guiding an Improved Dementia Experience (GUIDE) Model will focus on dementia care management and aims to improve the quality of life for people living with dementia, allow them to remain in their homes, and reduce strain on their caregivers.

The Center for Medicare and Medicaid Innovation (CMMI) will test the model, with the first of eight performance years running from July 2024 to July 2025.

“While we have made tremendous progress in improving care for people with dementia through the National Plan to Address Alzheimer’s Disease, people living with dementia and their caregivers too often struggle to manage their healthcare and connect with key supports that can allow them to remain in their homes and communities,” CMS Administrator Chiquita Brooks-LaSure said in the press release.

“Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden.”

The GUIDE Model will be available for participants who deliver supportive services to people with dementia, including person-centered assessments and care plans, care coordination, and 24/7 access to a support line.

To read more, go to Revcycle Intelligence.

Big Tech Player Dives Deep into Medial Imaging with ‘Purpose-Built’ Service

By Dave Pearson | July 31, 2023 | Included in Radiology Digest – August 8, 2023

The world’s most popular supplier of cloud services has become a dedicated radiology vendor.

Amazon Web Services announced the move last week, saying its offering—AWS HealthImaging—can help developers of cloud-native applications store, analyze and share medical imaging data at petabyte scale.

The company says healthcare providers can send data from imaging equipment straight to AWS HealthImaging for subsequent retrievals by radiologists working in PACS or other reading applications.

The announcement came as a blog post written by Tehsin Syed, general manager of Health AI, and Andy Schuetz, PhD, a principal product manager in the same division.

Among AWS’s product claims are low storage costs for image archives, thanks primarily to the infrastructure-obviating nature of the cloud, and simplified data migration from the edge to the cloud via AWS’s own gateways or those built by AWS partners.

The post names Philips as one such partner, saying the imaging giant plans to use AWS HealthImaging as a foundational element of their next-generation medical imaging suite.

The post quotes Philips’s chief innovation and strategy officer, Shez Partovi.

“Our cloud-enabled HealthSuite Imaging PACS intends to use AWS HealthImaging to improve experiences and accessibility for clinicians all over the world,” Partovi says.

Also already aboard are the Nvidia-founded medical AI framework Monai, the medical informatics company Dicomatics and, in the academic medical sphere, Wake Forest Baptist Health.

Syed and Schuetz state the move to concentrate on the medical imaging industry is a response to demand from healthcare providers and medical researchers.

“Both of these customer groups express a desire to have all their organization’s medical imaging applications work from the same store of data,” they write. “The cloud can help address these customer needs. With [AWS] HealthImaging, builders, like AWS Partners who provide medical imaging applications and research solutions, can focus more on tackling these customers’ challenges instead of worrying about infrastructure.”

AWS says it won’t charge for importing data to AWS HealthImaging, as pixel data encoding and metadata normalization are performed automatically.

Going by revenue and market share, Amazon Web Services is the biggest cloud provider globally, ahead of runners-up Microsoft Azure and Google Cloud Platform.

Blog post here, AWS HealthImaging webpage here.  
To read more, go to Health Imaging.                   

CT Should Not be Used to Screen for Colorectal Cancer, American College of Physicians Charges

Marty Stempniak | July 31, 2023 | Included in Radiology Digest – August 8, 2023

The American College of Physicians issued updated guidance for colorectal cancer screening of average-risk, asymptomatic adults on Monday, urging against the use of computed tomography colonography, or CTC. Its decision drew criticism from the radiology community, which has fought to increase awareness around this alternative to colonoscopy.

ACP said its decision was based on a critical review of existing clinical guidelines and evidence, which unearthed no eligible studies evaluating the effectiveness of CTC. The largest medical specialty organization in the U.S.—with over 160,000 members in internal medicine and related subspecialties—also advocated against stool DNA, capsule endoscopy, urine or serum screening tests.

“Computed tomography colonography also leads to a high frequency of extracolonic findings of uncertain benefit or harm,” Omar T. Atiq, MD, president of the American College of Physicians, told Radiology Business by email. “A positive CTC requires follow-up colonoscopy, which reduces its utility as a direct visualization test,” he added.

The American College of Radiology on Monday labeled the guidance as a “step backward—particularly in underserved communities where screening rates are lower and CRC death rates are much higher.” ACP’s announcement also recommends beginning routine screening at 50 years old rather than 45, contradicting advice from the American Cancer Society, which also has endorsed CT.

“About a third of those who should be screened for [colorectal cancer] can’t or won’t get a colonoscopy. We need more testing options—not fewer,” the American College of Radiology said in a July 31 statement.   

ACR also noted that the U.S. Preventive Services Task Force has endorsed CT as screening alternative to colonoscopy. Several studies have demonstrated that a “virtual colonoscopy” “significantly boosts” screening rates while lowering costs, the American College of Radiology added.

You can read the updated guidelines in the Annals of Internal Medicine, along with a corresponding editorial.

To read more, go to Radiology Business.

ACR Estimates Diagnostic Radiology Will Face 4% Medicare Cut, Absent Congressional Action

By Marty Stempniak | July 28, 2023 | Included in Radiology Digest – August 8, 2023

The American College of Radiology issued a detailed breakdown of the Medicare Physician Fee Schedule Friday, offering insight into the “complex” formula for how much the specialty stands to lose.

ACR noted the importance of budget neutrality, which requires corresponding cuts to counter any pay increases. The Centers for Medicare & Medicaid Services is proposing to implement add-on code G2211, billed primarily for office and outpatient evaluation and management encounters, next year, which impacts radiologist pay.

Medical societies have lobbied to delay implementation of this change, which was originally slated for 2019. But it’s now set to take effect in 2024, accounting for “roughly 90%” of the budget neutrality impact.

“There is often a great deal of confusion around the impact tables and conversion factor changes, as CMS calculations are often complex and difficult to decipher,” the college said in a July 28 news update. “As stated above, the rule is not final until published as such, and impact numbers are subject to change. In addition, each individual practice will experience unique impacts depending on case mix and services offered,” it added later.

ACR said it worked with Richard Heller, MD—a member of its economics commission and an associate CMO for Rad Partners—to crunch the numbers. Along with G2211, Congress added a 2.5% bump to the fee schedule conversion factor in 2023, which is being halved in 2024 to product for a 1.25% pay reduction. Changes to RVUs also add to the mix, ACR said, accounting for the other 10% of the budget neutrality impact.

Bottom line: DR stands to sustain a 3% decrease, 4% for interventional radiologists, 3% for nuclear medicine specialists, and 2% drop for radiation oncologists/therapy centers. But this does not include the impact of losing the 1.25% conversion factor bump from 2023, with the college forecasting final pay reduction figures to be about 1%-2% higher.

“The ACR estimates that without further congressional action, the reduction to diagnostic radiology will be approximately 4%, although as stated previously, the cut to any specific practice will vary based on types and volumes of codes billed,” the news updated noted.

You can read the professional association’s full 21-page breakdown of the 2024 MPFS for free here. ACR also issued a detailed breakdown of the 2024 Hospital Outpatient Prospective Payment System proposed rule, which can be found here.

To read more, go to Radiology Business.

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