CMS Seeks Comment on Secondary Interpretations

As our Enews last week reported, the Centers for Medicare & Medicaid Services (CMS) recently unveiled the 2015 Medicare Physician Fee Schedule (MPFS) proposed rule.  In the rule, CMS said they are investigating whether more routine payment of secondary interpretation of images by radiologists would actually generate cost savings by cutting down on potentially unnecessary duplicative imaging and keep patients from having to undergo unneeded additional exams.

CMS wants to closely examine payment for secondary interpretation of images. Here are a few of the questions on which CMS is seeking comment:

  • For which radiology services are physicians currently conducting secondary interpretations, and what, if any, institutional policies are in place to determine when existing images are utilized?
  • To what extent are physicians seeking payment for these secondary interpretations from Medicare or other payers?
  • Are there other settings other than a hospital where claims for secondary interpretations would be likely to reduce duplicative imaging services?
  • How should the value of routine secondary interpretations be determined?
  • Is it appropriate to apply a modifier to current codes or are new HCPCS codes for secondary interpretations necessary?

Break Away from the Static

As always, ADVOCATE will keep you updated on this and other issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA