ACR Receives Response on CT and MRI Prepayment Audits

This article was updated April 13 to reflect that Noridian received the ACR/RBMA response.

Noridian Healthcare Solutions, LLC recently replied to concerns raised by ACR® and the Radiology Business Management Association (RBMA) regarding audits of CPT® codes 74177 and 72148. ACR supports efforts to change Noridian’s prepayment Targeted Probe and Educated review of CPT® codes 74177, Computed tomography, abdomen and pelvis; with contrast material(s) and 72148, Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; without contrast material.

Radiology groups report major challenges meeting documentation requests for the professional component of these exams. In many hospitals, radiologists do not control the patient records needed for review, leading to high denial rates and financial strain on practices. In its response, however, Noridian outlined that these audits reflect CMS-directed medical review activities and emphasized the billing provider’s documentation responsibilities in the Program Integrity Manual. Medicare requires that all billed services be reasonable and necessary, and sufficient documentation must be submitted to support that requirement.

While the core issue remains, Noridian shared a “Dear Ordering/Referring Physician” letter designed to help billing providers obtain required documentation from ordering clinicians.

ACR and RBMA will review Noridian’s feedback and determine next steps to address radiology documentation error rates.

The ACR Contractor Advisory Committee Network continues to review and respond to payer policies that directly affect radiology practices. This issue remains a top priority because of its impact on workflow, reimbursement and patient care.

For questions about local coverage policies or this outreach, contact Alicia Blakey, ACR Manager of Economic Policy.