Earlier this month, the embattled bill to extend funding of Medicare and other federally sponsored health insurance programs finally became law. Stripped from the bills final version, however, was a provision that would have required imaging professionals and centers to become accredited by established radiology associations in order to remain eligible for Medicare reimbursement.
The removal of the provision was undoubtedly welcomed by a number of unaccredited providers. But in a twist that finds private payers setting the tone for national reimbursement trends, a number of insurers are moving forward with plans to increase their scrutiny of and standards for imaging-service providers.
The steps include moves by some insurers to mandate accreditation of imaging providers reimbursed by their plans. Other private payers are adopting benefits-management company initiatives to better educate referring physicians about the appropriate use of high-tech radiology procedures such as CT, MRI and nuclear medicine scans, as well as programs to inform primary-care doctors when their patients approach significant levels of radiation exposure.
The hope, healthcare-benefits experts say, is that such programs will reduce the number of unnecessary imaging procedures performed each year and eliminate poor-quality imagingproblems many observers say are the result of a long-growing trend toward nonradiologists owning and providing radiology services.
I attribute (the increase in unnecessary imaging) to the tremendous growth in self-referred imaging by doctors who have complicated leasing and ownership arrangements, says Thomas Greeson, a healthcare-law expert and a partner in the Falls Church, Va.-based law firm Reed Smith. Payers are trying to winnow away those providers.