Unfortunately, the Harkin-Snowe bill was never brought to a Congressional vote. Reimbursement rates in the Medicare fee schedule are listed in Table 1. At present, breast cancer accounts for 3.
Allocation of 0. In terms of cost per year of life saved, the cost-effectiveness of screening mammography is somewhat higher than that of cervical cancer screening, comparable to treatment for hypertension and screening for osteoporosis, but much less than that for coronary bypass surgery, renal dialysis, or use of automobile seat belts and air bags. While the ACR and other national organizations work to increase mammography reimbursement, there are also strategies that individual radiology groups may implement to affect their own profits or losses for breast imaging.
By law, all Medicare-participating providers must agree to accept the Medicare fee as payment in full. If radiologists prefer not to participate in the Medicare plan, they should know that recent regulations have placed limits on the amount of out-of-pocket fees that can be charged to a Medicare patient by a nonparticipating provider.
Radiologists who do not accept Medicare should also know that proper coding and billing can increase reimbursement and that this requires a complete understanding of the Medicare reimbursement system. A second option is to perform more interventional procedures. Reimbursement rates for percutaneous biopsy and aspiration are higher than those for mammography. Radiologist time for performing an interventional procedure should be kept to a minimum by having the procedure room set up and the patient ready beforehand.
A technologist or medical assistant should be with the patient at that time. A third strategy to improve revenues is for the radiology department to negotiate a contractual change with its hospital. The justification for this change is that breast imaging is a loss-leader that leads to downstream profits for surgery, radiation therapy, and oncology.
Screening mammography should also be perceived as a public health service, which is good public relations for the hospital. The fourth means to improve the economic picture at a breast-imaging center is to improve productivity. Unlike CT and MR, the major cost in mammography is professional and technical labor, rather than equipment. Thus, the radiologist should not have to perform any non-interpretive task that could be performed by a medical assistant.
Such activities include placing phone calls for the radiologist to speak with a referring physician, calling patients to return for additional imaging, handling paperwork, and placing screening films on the rotator and later removing them.
To ensure productivity, screening mammography should be performed at a different site and time from diagnostic mammography. For screening cases, batch reading is much more efficient than online interpretation. Excessive recall rates are an unnecessary inconvenience for patients and are unprofitable for the facility because diagnostic mammography will lose money. The number of "no shows" on the screening or diagnostic schedule must be kept to a minimum.
Patients should be sent a computer-addressed reminder letter several weeks before each appointment. Silva and the ACR are pleased with the decision, avoiding a potential decrease of 50 percent in technical component reimbursement for Large medical centers could have most likely absorbed the reduction and maintained mammography programs, but smaller imaging providers would have had a tougher time.
CMS cited the potential for restricting access to beneficiaries as a primary motivator in delaying the cuts.
Starting in January certain interventional radiology codes will be bundled, a change that will reduce reimbursement for some procedures. For example, cerebral arteriograms are currently reported with component codes, allowing doctors to receive payment for each vessel studied.
Instead, procedures performed in will be reported wholesale, probably resulting in a lowered payment for half of the codes. The ACR has lobbied against these changes, arguing that all cerebral arteriograms are equally work intensive, but CMS disagreed.
As a result, the investment in the upgrade would be justified and beneficial for shareholders. In order to maximize shareholder value, prudent operators need to conduct a thorough analysis of the expected earnings from the addition of tomosynthesis.
How do managers and operators quantify the incremental margin? One factor that must be considered is the incremental volume the center might receive from the competitive advantages discussed earlier. The expenses such as supplies, staff, etc. As for estimating potential revenue generated per incremental scan, the current reimbursement environment makes this quantification difficult to perform.
CMS has yet to establish separate and specific coding and therefore reimburses tomosynthesis at the conventional mammography rate. As a result, it would initially appear that additional revenue per scan would not be created from performing a tomosynthesis versus conventional screening. Some centers mitigate this by requiring patients to pay additional fees out of pocket to compensate for the added expense. Some commercial payors might pay additional reimbursement for tomosynthesis but that varies by market and by payor.
Most commercial payors currently consider tomosynthesis an investigative procedure and do not pay additional reimbursement. What about reimbursement going forward? G will also be an add-on to the existing digital mammography codes. CMS is still reviewing the entire mammography code family but some clarity on the subject should be available if centers check their local PFS.
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