Revenue & Reimbursement

Healthcare reimbursement is payment that a hospital, diagnostic imaging facility, subspecialty department or healthcare providers receive for performing a service. This also includes individual radiologist or cardiologist reimbursement and billing and coding rules for submitting claims.

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Philips-owned BioTelemetry to pay nearly $15M for allegedly misleading clinicians to secure higher reimbursements

The company and one of its subsidiaries would allegedly confuse clinicians and have them bill government programs for cardiac monitoring services that were more expensive than what they needed. This settlement resolves those allegations. 

December 20, 2023
Former managers of a Tampa Florida-based radiology company Advanced Diagnostic Group (ADG) and its employee stock ownership plan (ESOP) retirement benefit manager GreatBanc Trust Co. will pay $19 million to settle a class action lawsuit. The suit alleges they allowed the ESOP’s value to be diverted to managers, directors and their shell companies and away from employee participants. money gavel court lawsuit legal judge judgement

Kentucky health system, cardiologist to pay $3M for alleged scheme targeting Medicare and Medicaid

The alleged scheme involved a series of diagnostic procedures that, according to the U.S. government, were not medically necessary. 

December 7, 2023
insurance

Cardiologists lead push for Aetna to reconsider ‘restrictive,’ ‘inconsistent’ reimbursement proposals

The policies cover a wide range of interventional therapies, including Shockwave Medical's IVL technology and intravascular ultrasound. 

December 6, 2023
Ultromics EchoGo AI platform. When the Centers for Medicare & Medicaid Services (CMS) finalized the 2024 Hospital Outpatient Prospective Payment System final rule, it included an updated reimbursement for the EchoGo Heart Failure platform from Ultromics. EchoGo Heart Failure is now associated with an ambulatory payment classification (APC) code of APC 5743 and a payment rate of $284.88.

CMS increases reimbursement for AI-powered heart failure platform

Ultromics thinks the significant payment increase will help ramp up utilization among U.S. healthcare providers.

November 8, 2023
Barostim Neo 2 CVRx heart failure nerve stimulator on display at HRS 2023. Photo by Dave Fornell

CMS increases reimbursement for CVRx’s implantable Barostim device for heart failure

Implanting the Barostim device is now associated with an average payment amount of $45,000, up significantly from the previous average of $29,000.

November 3, 2023
Medicare money payment reimbursement dollar decline. More than 100 U.S. medical societies are throwing their support behind a new proposal that could reform out-of-date Medicare policies and help limit future payment cuts. 

Cardiologists, heart surgeons and imaging experts push for changes that could prevent ‘permanent and unjustifiable Medicare cuts’

More than 100 U.S. medical societies are throwing their support behind a new proposal that could reform out-of-date Medicare policies and help limit future payment cuts. 

November 3, 2023
Intravascular lithotripsy (IVL) therapy to break up calcified coronary lesions will now be reimbursed at a higher rate under new in-hospital codes the went into effect Oct. 1. Illustration of the Shockwave lithoplasty procedure using sonic waves to bust calcium without trauma.

IVL gains higher level of reimbursement with one of biggest coding updates for PCI in decades

Intravascular lithotripsy therapy to break up calcified coronary lesions will now be reimbursed at a higher rate under new in-hospital codes the went into effect Oct. 1.

November 1, 2023
Ken Rosenfield, MD, Mass General Hospital, explains the impact wider CMS reimbursement for carotid artery stenting will have on patient stroke care and interventional cardiology. CAS

Q&A: Ken Rosenfield explains the impact of new reimbursement coverage for carotid stenting 

Ken Rosenfield, MD, helped spearhead the recent Medicare policy change that made carotid stenting procedures available to more patients.

October 20, 2023

Around the web

Eleven medical societies have signed on to a consensus statement aimed at standardizing imaging for suspected cardiovascular infections.

Kate Hanneman, MD, explains why many vendors and hospitals want to lower radiology's impact on the environment. "Taking steps to reduce the carbon footprint in healthcare isn’t just an opportunity," she said. "It’s also a responsibility."

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