on April 12, 2013 |
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Topics: Utilization Review, Payer Relations, Reimbursement, Finance, Medicare, Payer and Regulatory Policy, Revenue Cycle, Imaging, Service Lines, Referral Management, Physician Issues, Utilization, Efficiency, Performance Improvement
Ben Lauing, Imaging Performance Partnership
President Obama’s proposed budget may signal major reforms in store for imaging. Self-referral, an issue often debated but rarely acted upon, is now an explicit target; the Obama administration has proposed restricting the in-office ancillary services exception to the Stark law. Furthermore, the budget suggests mandatory pre-authorization for advanced imaging modalities.
While this is only a proposed budget, and Congress could take it or leave it, we think it’s highly likely that regulations to curb imaging utilization will soon emerge.
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President Obama targets self-referrals and pre-authorization
on November 6, 2012 |
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Topics: Medicaid, Reimbursement, Finance, Imaging, Service Lines, CT, MRI, Referral Management, Physician Issues
Shaun Lillard, Imaging Performance Partnership
A report last week from the Government Accountability Office (GAO), the nonpartisan investigatory and auditing agency for Congress, found that in 2010 providers for advanced imaging services made close to 400,000 more referrals than they otherwise would have if they had not held a financial interest in the imaging equipment.
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Self-referrals in advanced imaging services costing Medicare millions
on October 8, 2012 |
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Topics: Reimbursement, Finance, Payer Relations, Imaging, Service Lines, Referral Management, Physician Issues
Stephanie Krent, Imaging Performance Partnership
Earlier this summer, the Office of the Inspector General released a new advisory opinion further clarifying the rules surrounding imaging providers' preauthorizations for imaging exams. Largely consistent with previous opinions, the OIG advised that sanctions would not be imposed on the radiology group seeking guidance.
As always, Gregory Demske, the chief counsel to the inspector general, warned that the opinion is limited to the specific facts presented in this case; however, understanding the opinion can help radiology leaders better tailor their own preauthorization processes.
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OIG gives green light to radiology group preauthorization
