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The Reading Room

Our latest update on all things imaging

Filtered by: Referral Management Hide

Time to examine self-referrals?

September 3, 2013

Shaun Lillard, Imaging Performance Partnership

According to a new study published in the American Journal of Roentgenology, self-referral is due for a reevaluation. 

A research team, headed by Dr. Timothy Amrhein of the department of radiology and radiological science at the University of South Carolina, found that physicians with a financial interest in the MRI equipment being used do have a bias toward increase utilization. The study supports the Obama administration’s proposal to restrict the in-office ancillary services exception to the Stark Law.

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Signs of financial relief for radiologists: New bill to repeal SGR clears House committee

August 6, 2013

Shanah Tirado, Imaging Performance Partnership

On Wednesday, July 31, the House Energy and Commerce Committee voted 51-0 in favor of the Medicare Patient Access and Quality Improvement Act of 2013—a bill that would repeal the Sustainable Growth Rate (SGR) formula for determining Medicare reimbursement. 

The SGR has driven CMS to slash reimbursements in an effort to aggressively reduce spending. Imaging has been under the microscope as a source of health system waste, experiencing aggressive rate cuts as much as 25% as a result. The new bill shows the promise of relief.

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Congress fights Stark law exception

August 1, 2013

Ben Lauing, Imaging Performance Partnership

Today, Representative Jackie Speier (CA-14), along with Representatives Jim McDermott (WA-7) and Dina Titus (NV-1), introduced the “Promoting Integrity in Medicare Act of 2013,” or “PIMA.” 

This bill would eliminate the in-office ancillary services exception to the Stark law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy.

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President Obama targets self-referrals and pre-authorization

April 12, 2013  | Comments (1)

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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Self-referrals in advanced imaging services costing Medicare millions

November 6, 2012

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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OIG gives green light to radiology group preauthorization

October 8, 2012

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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Arrests made in New Jersey kickback scheme

December 14, 2011

Michael Song, Imaging Performance Partnership

Fourteen health care practitioners across New Jersey were arrested this week on charges of participating in a bribery scheme to steer patient referrals to a community MRI center.  The arrests follow an investigation by the Office of the Inspector General that uncovered bribes made by directors at the Orange Community MRI Center to referring physicians.

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New Study Finds Financial Interest Increases Imaging Utilization

October 31, 2011

Stephanie Krent, Imaging Performance Partnership

In a study published this month by the American Journal of Roentgenology, Bhargavan and colleagues found new quantitative evidence to support what many have long suspected – that self-referring physicians image at a much higher rate than physicians with no financial interest at stake. While many prior studies have attempted to shed light on how financial interest can affect imaging utilization, several popular critiques have dampened earlier studies’ persuasiveness. What makes this study unique in the eyes of its authors, then, is not the result, but the methodology.

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