Ahmad M. Slim, MD, FACC, FASNC, FSCCT, associate professor of medicine, University of Washington, and regional chief medical officer, Pulse Heart Institute, Tacoma, Washington, explains how imagers get paid for coronary computed tomography angiography (CCTA) exams. He spoke on the topic in a session at the 2022 Society of Cardiovascular CT (SCCT) meeting.
Slim has been very involved in the reimbursement aspect as the SCCT representative to American Medical Association (AMA) CPT Panel, and as part of the American College of Cardiology (ACC) Coding Task Force. He is also a members of the SCCT Board of Directors.
"A lot of us, when we went through medical school and residency, we did not get a lot of training or education on how do we get paid and how do we get reimbursement for a new technology," Slim said. "In my session I wanted to demystify the process and help people understand how a new technology gets reimbursement."
Having been involved in the process, he explains from experience how AMA CPT codes are developed, including the professional description of the services provided, the technical component to perform the service, and the gathering of clinical evidence to show why the procedure or technology should be reimbursed based on improving patient outcomes.
He also explains the process and high importance of the of the Relative Value Scale Update Committee (RUC) survey, which is used to recommend relative value units (RVUs) to the Centers Medicare and Medicaid Services (CMS). Slim said the RUC survey is sent to providers to fill out so they can explain the workload involved in performing the exam or service. This provides a basis for the value sand resulting payment for the exam by CMS. This is the profession component of reimbursements. However, CMS reimbursements are often based on RUC surveys with very low numbers of responses because there is low interest in spending the time to fill out these involved documents.
The technical component of reimbursements includes the cost of the nurse, technologist, contrast and other factors and supplies needed to perform the exam.
The technical and the professional components can be combined into a global CPT bundled billing, or it can be separated. Slim said the professional component is often removed by hospitals when a study is being read by an outside radiologist or cardiologist, which would bill for the professional competent separately.
Unfortunately you learn all this on the job," Slim explained. "That is a shortcoming for all of us. The societies and even medical schools do not provide classes to explain this."
He said this has become an issue as reimbursements decline and it is clear more education is needed. "Regardless of all the advocacy efforts out there, it the basic members of the imaging societies don't understand the parts they need to succeed, no matter how much how much you advocate, that success will not be reachable because the majority of people do not have the tools to do it right. This is an area where all medical schools and societies could do better."
Slim said it is not just an issue about getting paid for services provided, it also impacts patient care if physicians do not understand the system or how to bill for it. "It's not just self-fulfilling, as in if we don't do it right we just wound get paid, it is also for the patient," he explained. "If we don't do it right, then patients will not get the procedures they need."
Full information on new codes can be found at the AMA website.
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com