Ken Davis Jr, JD continued his afternoon presentation on legal topics du jour with the topic of transcription, as addressed in OIG Advisory Opinion 07-19. Some language in the opinion has caused a bit of a controversy—the OIG has said hospitals can require radiologists to pay for their own transcription, and there have been instances of hospitals, physician groups and imaging centers coming to radiology groups and saying they have to make the groups pay for it.
“That is not what the OIG said,” Davis said. “The opinion is limited in its scope, and it is not a reimbursement opinion. There’s longstanding precedent, in my opinion, that says it should be part of the hospital reimbursement.”
Davis’ next topic was out-of-network and balance billing. He observed that state statutes and case law often impact how much participating and non-participating providers can charge HMO patients for covered services. The National Conference of Insurance Legislators recently proposed a bill that would require certain specific disclosures from health care facilities and facility-based providers (i.e. radiologists!), including itemized lists of services, a phone number where patients can discuss alternative payment arrangements, and contact information for the state medical board. For balances in excess of $200, providers would also be prohibited from reporting patients who can’t pay on time to a consumer reporting agency. Why should you care? Well, in some states, parts of this sample bill have been used as the basis for new legislation—including here in the great state of Texas. “Monitor developments in your state legislature,” Davis warned, “and be careful about the terms and conditions of ‘payor contracting’ provisions in your exclusive provider agreements.”
Next, Davis touched on accountable care organizations. “We’re moving toward localized, integrated entities for the provisions of health care,” he noted, “and unfortunately, radiology groups and imaging centers are at risk for being a cost center, not a profit center for ACOs.” His advice? “It’s like the PHOs of the early nineties: get involved early, be active, do everything you can to create value. People are less likely to screw you to your face, so it’s better to be at the table with them.”
Davis talked about the elimination of “purchased interpretation,” which was effective March 15 of this year. IDTFs can no longer bill their local contractor for out-of-state professional components, and instead must take reassignment from these out-of-state radiologists. The same rule applies if an in-state doc is under the supervision of another contractor. Davis offered an alternative: allowing radiologists to bill separately for all of the professional components they perform.
Finally, Davis covered the new PPACA requirement that radiologists store their Medicare beneficiary orders for seven years. CMS has indicated that these orders can be stored electronically, and the RBMA, ACR and others have argued that the TC supplier should be solely responsible for maintaining the order. “Be aware that some private payors are beginning to make the exact same demand,” Davis said, “and keep an eye on what, if any, further requirements CMS has. And make sure your professional service agreements and exclusive provider agreements make the TC supplier responsible—shift the responsibility now.”