Imaging Payment Update for 2012

Topics: Reimbursement, Finance, Medicare, Imaging, Service Lines, Outpatient Care, Market Trends, Strategy, Payer and Regulatory Policy, Revenue Cycle

Radiology’s future determined by multiple factors

2012 is shaping up to be an uncertain year for radiology. The political and regulatory forces in play—including the 2012 Medicare Physician Fee Schedule (MPFS) Final Rule, the 2012 Hospital Outpatient Prospective Payment System Final Rule, the continuing Sustainable Growth Rate (SGR) threat, and the impending congressional “Super Committee” proposal– are prompting providers to question likely outcome scenarios and their impact on the future of Medicare reimbursement for radiology.

Changes in the MPFS Final Rule

The 2012 MPFS Final Rule outlines several important changes that will have significant impact on the future of radiologist and imaging center reimbursement. For 2012, Medicare will expand the Multiple Procedure Payment Reduction to the professional component of advanced imaging exams and will continue to implement reductions in professional and technical reimbursement for most advanced imaging services.

Pros and cons of the HOPPS

For hospital radiology departments, the 2012 Hospital Prospective Payment System Final Rule provides some welcome relief alongside some unexpectedly significant cuts. After a year of drastically reduced hospital reimbursement for combined abdomen and pelvis CT examinations, Medicare has increased reimbursement back to 2010 levels. Unfortunately, reimbursement for vascular imaging remains volatile, with Medicare implementing significant cuts to its reimbursement in 2012.

Sustainable Growth Rate takes hold

Casting further uncertainty upon the future of Medicare physician payment is the fate of the Sustainable Growth Rate (SGR) formula which, barring what would be the thirteenth congressional intervention over the last decade, is currently written into the Final Rule with a physician payment reduction of 27.4% starting Jan. 1, 2012. Both Republicans and Democrats, alongside scores of physician advocacy groups, agree that a permanent SGR “fix” is needed. However, the staggering cost of overhauling the formula (approximately $300 billion) continues to represent a significant impediment to its replacement.

Log in and access the full report to learn more

Imaging Performance Partnership members can access the full report below to explore the details of the upcoming changes to imaging reimbursement and our guidance on navigating these modifications.