AMA Clinical Examples in Radiology - 2006 Bulletin 2
Update on Medicare Reimbursement Issues for 2007
Update on Medicare Reimbursement Issues for 2007 There have been many questions raised and some confusion about the multiple proposed rules released on the Medicare Physician Fee Schedule (MPFS) and the effect on payments for 2007. The following is provided to help clarify the various proposed rules issued and what is anticipated for 2007. The proposed rule issued by Medicare, dated July 29, 2006, covered the 2007 5-year review process, as well as the implementation of the practice expense data to make the practice expense values in the MPFS truly resource-based. The rule is of major concern to the...
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Article Overview
This article explains major Medicare reimbursement changes for 2007 as they relate to radiology and the physician fee schedule. It covers proposed and final rule activity, practice expense methodology, budget-neutral adjustments, the Deficit Reduction Act’s effect on imaging payments, multiple-procedure reductions, and the projected conversion factor change. It is aimed at radiology practices, coding and reimbursement staff, and others tracking Medicare payment policy.
Why This Topic Matters
The article helps readers understand why Medicare payment amounts for imaging and related services may change in 2007 and which policy drivers are affecting those changes. It is useful for assessing reimbursement impact, practice planning, and awareness of Medicare rulemaking.
Article Sections
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Medicare Physician Fee Schedule rule updates for 2007
Introduces the Medicare rulemaking activity affecting the 2007 fee schedule and explains the broad policy areas under review. It sets up the context for the reimbursement changes discussed later in the article.
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Five-year review and budget-neutral adjustments
Discusses the 2007 five-year review process, budget-neutrality mechanics, and the role of physician work and relative value updates. It also addresses concerns raised by professional organizations about sequencing and adjustment methodology.
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Practice expense methodology and bottom-up implementation
Covers the transition to revised practice expense inputs and the general approach Medicare is using to apply them. The section focuses on how the methodology affects technical component valuation across services.
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Imaging code examples and projected payment impacts
Presents a table of selected imaging and related services with projected technical component changes over the phase-in period. The examples illustrate the kinds of service-level payment shifts associated with the updated methodology.
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Deficit Reduction Act imaging provisions and multiple procedure reductions
Summarizes the DRA-related imaging payment provisions, including the comparison with hospital outpatient payment rates and the handling of contiguous-body-area reductions. It also notes how the ordering of these payment steps affects the overall impact.
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Conversion factor update and final rule timing
Notes the projected conversion factor change and the timing of the final Medicare rule. The section closes with a summary of the major reimbursement factors expected to affect radiology payments in 2007.
What You Will Learn
- What Medicare policy areas were changing for 2007 reimbursement
- How the five-year review and budget-neutral adjustments affected the fee schedule
- How practice expense methodology changes were being implemented
- What broad imaging payment issues were tied to the Deficit Reduction Act
- How multiple-procedure reductions and the conversion factor fit into the 2007 update
Who Should Read This
- Radiology practices
- Medical coders
- Reimbursement specialists
- Billing staff
- Practice administrators
- Healthcare consultants
Codes Discussed
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