Matthew Morrill, Technology Insights
Over the past year, many of our most progressive hospital members have asked us about an exciting new imaging technology—hybrid PET/MRI—with one major hesitation: reimbursement. As of June 11, 2013, there’s a lot less reason to worry.
A moment of clarity regarding PET/MRI reimbursement
Chris Pericak and Caitlin Visek
Falling reimbursement for extremity MRI exams performed in freestanding imaging centers may present hospitals with the opportunity to reap the benefit of these volumes—while simultaneously lowering costs and boosting patient satisfaction.
Declines in imaging center reimbursement may offer new opportunity
In May of this year, CMS granted formal approval for TAVR reimbursement, focusing strong attention on the financial picture of transcatheter aortic valve replacement (TAVR). The ruling mapped TAVR ICD-9 procedure codes 35.05 (transfemoral access) and 35.06 (transapical access) to MS-DRGs 216-221. While the Medicare national average payment is between $25,000 and $55,000 for these cardiac valve MS-DRGs, the payment rates at centers likely to qualify for TAVR are considerably higher; in fact, in FY2011, the payment for hospitals performing 50 or more aortic valve replacements (AVRs) was between $35,000 and $74,000, according to MedPAR data.
UPDATE: Recent CMS reimbursement coverage calls attention to TAVR financial picture