Radiology Digest – November 14, 2023

November 16, 2023

Radiology Digest: News from the week of November 14, 2023.

Senate Finance Committee Advances Bill to Mitigate Radiologist Pay Cuts in Medicare

By Marty Stempniak | November 9, 2023 | Included in Radiology Digest – November 14, 2023

The U.S. Senate Finance Committee on Wednesday advanced a bill that would partially protect radiologists and other specialists from a planned Medicare pay cut in 2024.

Lawmakers passed the Better Mental Health Care, Lower Drug Cost, and Extenders Act in a 26-0 vote, advancing it out of the committee. CMS issued the final 2024 physician fee schedule on Nov. 2, including a 3.4% reduction to the conversion factor used to translate RVUs into payment. The committee proposal would mitigate 1.25% of this cut, along with several other policy changes.

“This package provides a one-year increase to Medicare physician payment. Our goal is to shore up Medicare’s effort in 2024 to boost payment for primary care,” Committee Chairman and Sen. Ron Wyden, D-Ore., said in prepared remarks delivered Nov. 8. “Next year, the Finance Committee will take a deeper look at Medicare physician payment as several provisions in current law need to be reexamined.”

Both Wyden and Ranking Member/Sen. Mike Crapo, R-Idaho, praised the committee for moving the legislation along to the full Senate.

“I thank Senator Wyden and every member of the Committee for their partnership in this effort, and look forward to advancing this comprehensive, deficit-cutting, bipartisan legislation,” Crapo said in a statement.

Absent any congressional action, diagnostic radiology will face a 3% pay decrease, while interventional specialists can expect an aggregate 4% reduction. If the legislation eventually passes, it would have the effect of making the conversion factor $33.1485 rather than $33.7442, a decrease of 2.18% instead of 3.37%, Healthcare Administrative Partners estimated Wednesday.

The Congressional Budget Office, meanwhile, calculated that the fee schedule change proposed under the Better Mental Health Care, Lower Drug Cost, and Extenders Act would cost $670 million over 10 years.

To read more go Radiology Business.

TAKE ACTION HERE! Tell Lawmakers to Avert Cuts to Medicare Reimbursement.


7 Prior Authorization Updates

By Andrew Cass | November 7, 2023 | Included in Radiology Digest – November 14, 2023

From UnitedHealthcare starting its second wave of cuts to lawmakers urging CMS to increase its oversight of artificial intelligence used in Medicare Advantage prior authorizations, here are seven updates on prior authorization Becker’s has reported since Sept. 18. 

1. CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. 

2. A group of lawmakers is asking CMS to increase its oversight of artificial intelligence used in Medicare Advantage prior authorization. 

3. Blue Cross Blue Shield of Massachusetts is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1.

4. The second and final wave of UnitedHealthcare’s prior authorization cuts began Nov. 1.

5. The Better Medicare Alliance is recommending a set of policies to Congress and CMS to improve prior authorization, behavioral health access, equity and more in the program. 

6. Blue Cross Blue Shield of Michigan intends to cut 20 percent of its prior authorization requirements. James Grant, MD, the payer’s senior vice president and chief medical officer, told Becker’s the changes are part of an evolving process.

7. UnitedHealthcare and Cigna’s prior authorization cuts are steps in the right direction, but the American Medical Association is “careful not to confuse positive developments with major progress,” the organization’s immediate past president Jack Resneck, MD, said. 

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


Consumer Credit Scores Improve After Medical Debt is Wiped from Reports

By Victoria Bailey | November 6, 2023 | Included in Radiology Digest – November 14, 2023

After major credit bureaus stopped reporting medical debt collections less than a year old and less than $500, consumers saw improvements in their credit scores, according to data from the Urban Institute.

Medical debt can lead to financial challenges, especially when unpaid debt is sent to collections and winds up on consumer credit reports.

Medical debt does not accurately predict a person’s credit risk, as unpaid bills could reflect issues with understanding healthcare billing and reimbursement processes. However, having medical debt in collections could impact someone’s ability to get insurance, find a job, or rent a home.

Last year, three major credit bureaus—Equifax, Experian, and Transunion—announced that starting July 1, 2022, they would increase the time before past-due medical debt collection appears on a consumer credit report from six months to one year.

In August 2022, the Vantage score consumer credit model, one of the country’s most used models, stopped using medical debt in collections to calculate credit scores. Furthermore, in April 2023, the three major credit bureaus removed medical collections under $500 from consumer credit reports.

According to the Urban Institute’s credit bureau data, these changes have eliminated medical debt in collections from most consumers’ credit reports.

In August 2022, 11.6 percent of consumers had medical debt in collections on their credit reports. By August 2023, the share declined to 5.0 percent. Urban Institute researchers estimated that more than 15 million consumers have benefitted from the debt erasure in the past year.

Additionally, consumers’ credit scores have increased since the changes were implemented. Between August 2022 and August 2023, the average credit score among consumers with medical debt collections in August 2022 rose from 585 to 615 points. This shifted many consumers from a subprime level (below 600) to near prime level (between 601 and 660).

At the same time, the average credit score for consumers without medical debt on their records remained largely the same, going from 712 to 711 between August 2022 and August 2023.

These findings indicate that future medical debt reporting restrictions could continue benefiting consumers. The Consumer Financial Protection Bureau (CFPB) recently proposed a rulemaking process that aims to remove all remaining medical bills from consumer credit reports.

Additionally, two states have taken legislative action to address the issue. Colorado’s law banning medical debt from appearing on credit reports went into effect in August 2023, while New York’s law passed the state legislature in June 2023 and is currently being reviewed by the governor.

Although these policies may help consumers have better credit scores, they do not address the numerous other challenges accompanying medical debt, including the fact that consumers will still owe the debt to their healthcare providers.

Most hospitals, providers, and collection agencies can still sue patients for not paying medical bills. In addition, removing medical debt from credit reports may cause these entities to increase their efforts to receive upfront payments before delivering care, the report mentioned.

To read more, go to Revcycle Intelligence.


Medicare Finalizes 2024 Physician Fee Schedule with Radiologist Pay Cuts, Pause of AUC Program

By Marty Stempniak | November 3, 2023 | Included in Radiology Digest – November 14, 2023

The Centers for Medicare & Medicaid Services on Thursday issued the final 2024 physician fee schedule, which includes radiologist pay cuts and a pause of the imaging Appropriate Use Criteria program.

CMS has finalized a 2024 conversion factor (the dollar amount used to convert RVUs into payment) of $32.74, a 3.4% (or $1.15) decrease from last year. Absent any congressional action, diagnostic radiology will face a 3% pay decrease, while interventional specialists will see an aggregate 4% decrease, versus a 3% drop for radiation oncologists, experts estimated.

The actual impact could be worse, the American College of Radiology noted, as these numbers do not account for payment changes tied to the Consolidated Appropriations Act. Physician advocacy groups including the American Medical AssociationMedical Group Management Association and the American Society for Radiation Oncology criticized the final fee schedule following its release.

“Again, CMS has placed physicians and especially radiologists in a position to examine an unclear path forward as practice expenses increase and Medicare reimbursements decline,” Radiology Business Management Association Executive Director Bob Still said Thursday. “Radiologists continue to get a smaller piece of the Medicare physician pie. RBMA and other organizations will come together to work with Congress to correct the inequity in Medicare physician payments.”

Overall, CMS has reduced finalized payment amounts under the fee schedule by 1.25%, “in accordance with update factors specified by law,” the agency noted.

Medicare also is moving forward with payment increases for many services, including primary and “longitudinal” care.

As first proposed in July, CMS confirmed that it is pausing implementation of the long-delayed imaging Appropriate Use Criteria program, including ending the current educational and operations testing period. First established in 2014, the initiative requires physicians to consult a decision-support system before ordering MR, CT and other advanced imaging to help curb healthcare waste. But it’s been plagued by postponements and other challenges.

The American College of Radiology, which has supported the program, acknowledged the pause while holding out hope that AUC could return in the future.

“The ACR recognizes the significant issues CMS faces with the real-time claims processing aspect of the AUC program and the potential impact on our members should claims be denied inappropriately,” ACR said in its initial analysis of the final fee schedule, issued late Thursday. “The college is working with Congress to streamline and modernize the [Protecting Access to Medicare Act’s] AUC program, including the removal of this requirement, to allow the program to move forward and ensure Medicare patients receive the right imaging tests at the right time.”

The payment schedule confirms that the Medicare Economic Index—a government measure of inflation in medical practice costs—increased at 4.6%. This would mark the highest uptick this century, the AMA noted, and is on top of a 3.8% increase last year. When adjusting for inflation, Medicare physician payment effectively declined 26% between 2001 to 2023, before including these cuts, the association noted.

“This is a recipe for financial instability. Patients and physicians will wonder why such thin gruel is being served,” AMA President Jesse M. Ehrenfeld, MD, said Thursday.

Advocates believe these numbers underline the need for legislative fixes such as the Strengthening Medicare for Patients and Providers Act. The bipartisan bill would provide a permanent annual inflationary physician payment update tied to the Medicare Economic Index.

“The AMA and house of medicine strongly urge Congress to advance this legislation,” Ehrenfeld added.

You can read more about the final fee schedule in the CMS press release, corresponding   fact sheet and the 2,709-page rule itself. The policies will be effective beginning Jan. 1.

To read more, go to Radiology Business.


Medicaid Disenrollments Top 10 Million

By Rylee Wilson | November 2, 2023 | Included in Radiology Digest – November 14, 2023

More than 10 million people have been disenrolled from Medicaid since continuous coverage requirements ended in April, according to KFF. 

In April continuous coverage requirements put in place during the COVID-19 pandemic ended, and states began redetermining Medicaid beneficiaries’ eligibility for the program for the first time since March 2020. 

As of Nov. 1, at least 10,046,000 people had been disenrolled from Medicaid coverage, according to KFF. Of those disenrolled, 71 percent had their coverage terminated for procedural reasons, rather than being determined no longer eligible for the program. 

Disenrollment stats vary widely by state. In Texas, 65 percent of individuals up for renewal have had their coverage terminated, while just 10 percent of individuals up for renewal in Illinois have lost their coverage. 

Texas has the largest number of disenrolled individuals, at 1.2 million, according to KFF. States have 12 months to complete the Medicaid unwinding process. Four states began in April, with most states beginning in June or July.
To read more, go to Becker’s Payer Issues.


ACS Updates Guidelines, Recommends Lung Cancer Screening for 5 Million More Americans

By Chad Van Alstin | November 2, 2023 | Included in Radiology Digest – November 14, 2023

The American Cancer Society (ACS) has updated its guidelines for lung cancer screening, recommending that nearly 5 million more Americans undergo CT scans. This marks the first change to the screening recommendations in a decade. 

The new guideline suggests screening for anyone between the ages of 50 and 80 who currently smokes or formerly smoked cigarettes, defined as 20 packs a year or more.

Previously, the recommendations specified screening for adults ages 55 to 74, with a 30 pack per year history, both current smokers and those who quit 15 or fewer years ago.

The new guidelines no longer consider the number of years since quitting smoking. The ACS said that while quitting smoking reduces the risk of lung cancer over time compared to continued smoking, the risk remains higher for all former smokers than nonsmokers.

The updated ACS recommendation aligns more closely with that of the U.S. Preventive Services Task Force (USPSTF), an independent panel of medical experts, which also suggests annual CT screening for individuals age 50 to 80 with a 20 pack-year smoking history. However, the USPSTF recommendation is limited to individuals who currently smoke or have quit within the past 15 years, much like the ACS guidelines from 2013.

Most insurers are required to cover preventative lung screenings without cost-sharing due to the USPSTF endorsement.

To read more, go to Health Imaging.

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