New Jersey Radiologists will soon begin to feel the effect of new balance billing rules lawmakers passed, with intentions of protecting patients from “surprise bills.” On June 1, 2018, New Jersey Governor Phil Murphy signed the “Out of Network Consumer Protection, Transparency, Cost and Accountability Act.” The new law will go into effect on September 1, 2018.  Once the law is in place, patients will have an arbitration resource to dispute balance bills from out-of-network providers.

APS reported to the 2017 MIPS (Merit-Based Incentive Payment System) program on behalf of approximately 700 clinicians and we’re happy to report that all met, or exceeded, the program requirements to avoid a negative payment adjustment in its inaugural year.  As a result of the data-mining capabilities of our contracted MIPS qualified registry, many of our clients earned a perfect score of 100%, earning them the top positive payment adjustment available for the performance year. 

The radiologist’s report serves many purposes beyond the clinical diagnostic realm:  compliance, legal and billing entities also depend on a thoroughly-documented report to fulfil their functions.  What might appear as a small detail often directly impacts the CPT code(s) chosen for the service.  Click here to review our white paper, ‘Documenting a Complete Interpretation Report for Diagnostic Radiology Services,’ on the APS website for insight and documentation

In February 2018, Assemblyman Ash Kalra (D-San Jose) introduced Assembly Bill 3087 (AB3087) to the California Legislature.  The proposal is intended to curb healthcare costs by imposing price controls on commercial insurance plans.  This bill was backed by labor unions and consumer groups, but faced intense opposition from physicians and hospitals.  AB3087 would create a state commission for enforcement and oversight, effectively capping payment for all services and creating a model very close to a single payer system.  Thankfully, this was shelved for consideration by the Assembly Appropri

The industry has begun preparing for the implementation of the AMA’s 2019 CPT code set.  Significant updates to the codes for Fine Needle Aspirations (FNA) will change the coding and billing of these services, come January 1. 

Out-of-Network balance billing of patients continues to be a hot topic at the state level in 2018. This occurs when a patient receives out-of-network medical care and is then responsible for a balance much higher than expected. Often times, this balance can cause financial hardships, driving many states to develop legislation to protect patients from these unexpected costs. There are still many states that do not have legislation regulating this practice, but both New Hampshire and Washington are looking at ways to lessen the liability of balance billing.

In early July, 2018, CMS released its proposed fee schedule for Calendar Year 2019.  This proposed rule included a flattening out of reimbursement rates for Evaluation and Management (E&M), effectively reimbursing the same rate for level 2 services, as it allows for level 5 services.  With one of the most common E&M services falling into the level 3 category, this should see an increase of payment for the average new or established visit.  To accommodate longer and more complex appointments traditionally described and paid at higher rates as level 4 and level 5, the CMS has proposed

The Merit Based Incentive Payment System (MIPS) is in its second year and, as with last year, radiologists are exempt from MIPS category Promoting Interoperability (previously called Advancing Care Information and, before that, Meaningful Use), leaving three categories they will be scored on:

1.  Quality – Clinicians will report a full year’s worth of data on at least 6 measures, one of which must be defined as an Outcome or High Priority measure

As in previous years, the AMA completed their National Health Insurer Report Card, outlining the countless issue with carrier’s correctly processing and paying claims.  According to the 2012 study, it was found that commercial payors allowed amounts match individual practices expected payment levels 90% of the time.  This means that 1 out of 10 line items are effectively underpaid.  APS’ proprietary contract management system continues to monitor payment levels by line item to identify these mistakes.  Underpayments are flagged in real time and a specialist is notified to contact the at fau

As a means to allow individual consumers to purchase health care coverage and an affordable rate, “ObamaCare” allows for the creation of insurance exchanges.  These marketplaces are intended to allow insurances to compete for business by offering competitive rates to individuals.  Recently, APS has begun receiving notification of certain PHOs taking advantage of these exchanges, with the result being lower reimbursement.  Most notably are contract terms paying 100% of current year (2012) Medicare.  APS will keep each client informed to these offers and work tirelessly to negotiate fair reim



APS brought a more systematic and complete treatment of our billing, which resulted in a significant improvement in payments.

Salem, OR

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