AMA Clinical Examples in Radiology - 2011 Bulletin 1
Aetna's Multiple Procedure Reduction Policy Impacts Technical and Global Payments
Aetna's Multiple Procedure Reduction Policy Impacts Technical and Global Payments Aetna implemented a new claims payment policy for dates of service on or after February 1, 2011, whereby reimbursement for second and subsequent computed tomography, magnetic resonance imaging, or ultrasound studies on the same date of service is reduced by 50 percent. Aetna based this policy on the Centers for Medicare and Medicaid Services' (CMS') multiple procedure payment reduction policy for diagnostic imaging procedures. The Aetna policy differs from the CMS policy in that the reduction applies to global charges as well as technical charges for facility and medical...
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Article Overview
This article covers an Aetna claims-payment policy update for imaging services and the resulting concerns raised by radiology organizations. It is relevant to radiology practices, billing staff, and compliance teams that need to understand how payer policies may affect technical, global, and professional billing arrangements. The article also places the policy in the context of CMS-related multiple procedure reduction concepts and discusses contract and billing-structure considerations at a general level.
Why This Topic Matters
Payer policy changes can alter reimbursement patterns for imaging services and affect how claims are billed and paid. Understanding the scope of the policy and the concerns raised by professional organizations helps practices evaluate contractual exposure and billing workflow impact.
Article Sections
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Policy change and payment impact
Summarizes the payer policy update and the general categories of imaging services affected. It describes the broad payment areas impacted on claims without providing operational details.
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Professional response and payer discussion
Describes objections raised by radiology organizations and the subsequent discussion with payer ներկայացուցիչs. It addresses the broader concerns about implementation and billing structure.
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Contact and publication information
Provides article publication details and contact information for follow-up. This section does not add substantive coding or reimbursement guidance.
What You Will Learn
- The scope of an imaging-related payer payment policy change
- How radiology organizations responded to the policy
- The general reimbursement and billing areas the policy may affect
- Why contract terms and billing structure may need review
Who Should Read This
- Radiology coders
- Billing staff
- Practice managers
- Compliance teams
- Revenue cycle professionals
Modifiers Discussed
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