Reimbursement

Procedures performed in hospital outpatient departments and physician offices must comply with physician supervision requirements established by CMS. These requirements often differ depending on the type of service and setting where the procedures are performed.

The Medicare Accessibility and CHIP Reauthorization Act (MACRA) introduced several changes to the physician reimbursement framework. It replaced the Sustainable Growth Rate formula with the Quality Payment Program to provide incentives that emphasize value and quality of care over volume.

Representatives of the ACR Radiology, Radiation Oncology, and Nuclear Medicine Carrier Advisory Committee (CAC) Network advocate on behalf of radiology for fair reimbursement policies at the local Medicare level.

The Centers for Medicare & Medicaid Services (CMS) recently issued an MLN Matters article reminding how hospitals that bill for outpatient Intensity-Modulated Radiation Therapy (IMRT) planning services should bill Medicare correctly and avoid overpayments.