Economics Update
CAC Networks Monitor Local Medicare Issues
State leaders of local Medicare reimbursement policy for radiology, radiation oncology, and nuclear medicine convened for the ACR Carrier Advisory Committee (CAC) Networks meeting on April 11. Members of the CAC networks, with the assistance of the ACR, advocate on your behalf by discussing important coverage issues such as coronary CT angiography, PET and CT colonography, and reimbursement in order to ensure local Medicare carriers are complying with proper CPT® coding, and national coverage determinations by the Centers for Medicare and Medicaid Services. For example, CAC representatives from California, Maine, Massachusetts, New Hampshire, and Vermont succeeded in obtaining expanded coverage of CT colonography and CAC representatives from Pennsylvania succeeded in clarifying the proper coding of coronary CT angiography.
In addition, CAC representatives monitor and discuss reform of the local Medicare process mandated by Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This reform calls for the replacement of all Medicare carriers and fiscal intermediaries with Medicare administrative contractors, who will administer both Medicare Part A and Part B claims and will be selected through a competitive bidding process (see related story in the June 2005 ACR Bulletin). Another CMS initiative affecting physicians at the local level is the recovery audit contractor (RAC) demonstration project, which will examine Medicare claims in California, Florida, and New York for improper payments not found through existing integrity efforts. When overpayments are detected, the RAC will collect the overpaid funds and retain a percentage as compensation.
The ACR, through the CAC networks, continues to actively monitor these CMS initiatives. For more information on the ACR CAC network, contact Kathryn Keysor in the Economics and Health Policy Department at (800) 227-5463, ext 4950.
Chapter Representatives Meet to Discuss ACR Private Payer Initiatives
The ACR Managed Care Committee and Managed Care Network met during the Annual Meeting and Chapter Leadership Conference to discuss the College's top priorities in the private payer arena for the coming year. The committee will develop new resources to assist members in dealing with practice management issues and to educate them about incorporating quality and safety standards into radiology services.
In the past year, the Managed Care Committee and Network were instrumental in influencing Aetna to reimburse for computer-aided detection for mammography (CPT® codes 76082 and 76083), and to reinstate coverage for the continuing medical physics consultation service (CPT® code 77336). The committee will continue to work on private payer problems at both the local and national levels. Members who need assistance addressing a problem in their state can contact Angela Stanley at (800) 227-5463, ext 4560.