Those hoping for a repeal of cuts to diagnostic imaging contained in the Deficit Reduction Act (DRA) may have to drastically lower their expectations for 2006 was the word coming out of both the American College of Radiology (ACR) Annual Meeting and Chapter Leadership Conference and the National Coalition for Quality Diagnostic Imaging Services (NCQDIS) Member’s Conference. Both conferences, held just 2 weeks apart, drew large contingents to Washington, DC, to lobby against the cuts, particularly the provision in the DRA to reduce the technical component for diagnostic imaging services to the lower of either the reimbursement under the Medicare Physician Fee Schedule (MPFS) or the Hospital Outpatient Prospective Payment System (HOPPS).

READ THE FULL STORY IN LEGISLATIVE REPORT >>

The following conditions must be met for the non-monetary compensation up to $300, Davis said:

Is Arranging for Pre-Certs a Kickback?
As imaging centers get increasingly savvy about managing payor denials, many have begun to actively seek pre-certification for their patients, a task normally performed—albeit not very diligently—by the referring physician. The above question arose many times during the RBMA 2006 Radiology Summit from attendees who wondered if proactive efforts to ensure pre-certification could
be construed as an inducement for referrals instead.

During a talk entitled Managing Payor Restrictions Christie D. James, billing manager for Massachusetts General Physicians Organization, Boston, reported that more than seven MGPO payors require pre-certification for advanced imaging studies, and more than half of the outpatient volume requires pre-certification. MGPO added 5 FTEs and a centralized pre-certification to manage the process for hospital, global, and professional billing. When the question arose during James’ talk, she explained that the MGPO had pre-arranged with payors to perform pre-certs.

The question rose again following W. Kenneth Davis, Jr, JD’s talk, Most Frequently Asked Legal Questions About Marketing Your Practice. When an attendee reported that a payor (Aetna) considered their efforts to acquire pre-certification for providers “an unfair inducement for referrals,” Davis replied that what private payors ask for is largely based on their contracts with the provider, and if that contract specifies that the pre-certification function must be discharged by referring physicians, then it could be considered a breach of contract if the radiology provider obtains the pre-certification. When it comes to Medicare, Davis does not believe the practice can be construed as is an inducement for referral, with the following provisions: “We do not believe it is illegal for radiology groups to provide pre-certification to all clients as long as you do it across the board and that you can demonstrate you have unique qualifications to do that and that in effect it has been part of the technical component to do this.”

READ MORE
Radiology Group of Abington: The Quest to End Denials
http://www.imagingeconomics.com/library/200605-01.asp