Industry News Round Up

MSN Healthcare Solutions Industry News Round Up
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Topics Covered

Proposed New Legislation for Radiology Assistants’ Services

U.S. Rep. Mike Doyle (D-PA) unveiled H.R. 3657, the Medicare Access to Radiology Care Act (MARCA) in June drawing support from the imaging industry. The bill proposes to amend title XVIII of the Social Security Act to provide for the payment to the employer for services performed by a radiologist assistants under the Medicare program. In late 2018, Medicare amended its payment policy to adjust the radiologist supervision levels for radiologist assistants.

Some industry leaders are asking for adoption of the proposal and to also ensure that regardless of the setting for the performance of radiology services; hospital, critical access hospital, ambulatory surgical center or any other facility setting, that services provided by a radiologist assistant that is supervised by a radiologist as part of a radiologist-led patient care team receive complete Medicare reimbursement.

The recommendation seeks to make the change by not separating radiologist assistant reimbursement policies into different payment categories and methodologies by service location.

The adoption of MARCA would enable radiologists to focus their time to more complex medical images or response to serving more urgent patient cases. These changes would provide better patient outcomes and increases access to care for patients.

Without the adoption of these necessary changes, radiology assistants face a challenging and uncertain future.

Bill History

6/01/2021
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
– Action By: House of Representatives

Florida Governor Expands PA Scope of Practice

Florida Governor Ron DeSantis signed House Bill (HB) 431 into law June 29. This law increases the number of physician assistants (PAs) a physician may supervise at any one time from four to 10 and removes the requirement that a PA notify a patient of the right to see a physician prior to them prescribing or dispensing a prescription.

Additionally, the law authorizes a PA to supervise medical assistants and allows a PA to directly bill and receive payment from third-party payors for the services they deliver.

CMS Calendar Year (CY) 2022 MPFS Proposed Rule for Physician Assistant (PA) Services

CMS is proposing to implement section 403 of Division CC of the CAA that authorizes Medicare to make direct payment to PAs for professional services they furnish under Part B beginning January 1, 2022.

Currently, Medicare can only make payment to the employer or independent contractor of a PA and  PAs could not bill and be paid by the Medicare program directly for their professional services. Further PAs have no option to reassign payment for their services or to incorporate with other PAs to bill the program for PA services. If adopted in the Final Rule, beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services.

Important – Many times the language and intent of the Proposed Rule will change before the Final provision is adopted. We will wait and see.

WPS – Mammography Payment Correction

While Medicare requires a physician (MD/DO) to perform the professional component and to supervise the technician performing the technical component of a mammogram, WPS were in error when they found they had paid certain specialties for mammograms.

So, effective for claims processed August 2, 2021, and forward, WPS will no longer pay for mammograms provided by these specialties: 

  • 50 – Nurse Practitioner
  • 89 – Clinical Nurse Specialist
  • 97 – Physician Assistant

This includes these specialties for these services:

  • Global service
  • Technical component (TC modifier)
  • Professional component (26 modifier)

The procedure codes to which this will apply include:

  • 77063 – Screening digital breast tomosynthesis, bilateral
  • 77065  – Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
  • 77066  – Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • 77067 – Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
  • G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)

    National Coverage Determination (NCD) for Mammograms (220.4) (cms.gov)

New Codes for Artificial Intelligence (AI)

While new codes for AI were released July 1, 2021, for an effective date of January 1, 2022, there are certainly some expected payment challenges.

Category III CPT codes are temporary codes designed for emerging technologies, services, and procedures. These codes then result in collection of data to create documentation for U.S. Food and Drug Administration (FDA) product clearance and to validate the general clinical application and ultimately petition for a Category I CPT code. It is not uncommon to take two, three years or more before we payers reimburse for these services

However, we do encourage providers to use the codes and services in order to provide information for data collection and to expedite a reimbursable CPT code. Some arrangement including a self-pay option should be considered for these services for now.

New Code Sets for AI and Documentation Language

 

  • Code 0691T – Applies to the use of AI for automated analysis of existing CT studies for vertebral fracture(s), including assessment of bone density when performed, data preparation, interpretation, and reporting.

    • “Artificial Intelligence (AI) was utilized for analysis of existing CT studies for vertebral fracture(s)”

  • Code 0554T – Includes the determination of bone strength and fracture risk using finite element analysis, a computer simulation technique that utilizes functional data and analysis of bone mineral density from a CT scan.

    • “Bone strength and fracture risk was determined by finite element analysis of bone mineral density from the patients previous CT scan”

CMS Renews Reimbursements for Viz.ai stroke AI software

On August 4, 2021, CMS renewed a reimbursement structure to pay clinicians for the use of Viz.ai’s artificial intelligence (AI) stroke software. CMS granted new technology add-on payment (NTAP) renewal status for the use of Viz.ai’s Viz LVO, which was formerly known as Viz ContaCT, an AI algorithm that detects strokes on CT scans.

NTAP – CMS Inpatient Prospective Payment System (IPPS) supports cutting-edge technologies that have demonstrated substantial clinical improvement and ensure early availability to Medicare patients.

However, the NTAP payment applies to the hospital inpatient DRG. This is not a physician billable service and is not part of the MPFS.

CMS Dropping NCD for PET Imaging for Non-Oncologic Care

Under the recently released 2022 Medicare Physician Fee Schedule,  CMS is proposing to retire the “outdated” non-oncologic restrictions. However, CMS is asking each Medicare MAC to develop their own policies for PET Imaging for Non-Oncologic care.

Doctor comparing lungs x-rays for lung cancer screening

USPSTF Recommends Changes to Lung Cancer Screening

The U.S. Preventative Services Task Force is making recommendations to nearly double the number of people eligible for tests. The recommendation is seeking to lower the starting age for lung cancer screening from 55 to 50.

USPSTF is also recommending expanding the high-risk population to include those who smoked the equivalent of a pack of cigarettes a day for 20 years, rather than a 30 pack-year history. This change applies to adults between 50 and 80 years who currently smoke or have quit within the past 15 years.

Not Too Fast....

Some hospitals are moving forward with the recommendations, while payors are working through the changes.

CMS Update

In May, the GO2 Foundation for Lung Cancer, The Society of Thoracic Surgeons, and American College of Radiology® (ACR®) petitioned for a change to the CMS National Coverage Determination policy. While ​CMS accepted their request, the completion date is not expected until February 2022.

Aetna Update

Aetna revised their lung cancer screening coverage policy in accordance with USPSTF recommendations. Aetna’s coverage policy, retroactive to March 8, covers annual low-dose computed tomography (LDCT) for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years.

BCBS of Kansas Update – Effective date September 1, 2021

BCBS of Kansas followed suit and revised its lung cancer screening coverage policy. BCBS of Kansas coverage policy, effective September 1, 2021, will also allow for annual low-dose computed tomography (LDCT) for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years

Medicaid and Other Payors

Medicaid Services (CMS) is also considering an adjustment to its reimbursement policy for low-dose CT lung cancer screening. While there has been no formal announcement of change other payors are considering some form of adoption of as well.

Kim Snyder, Certified Professional Coder

Kim Snyder
Certified Professional Coder, Director of Physician Education

Kim Snyder is a Certified Professional Coder (CPC) with more than 20 years of experience in healthcare coding and compliance.  She joined MSN Healthcare Solutions in 2016 and currently serves as Director of Physician Education, specializing in the development of educational materials and programs designed to improve complete and compliant documentation.