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.

AMA president warns prior authorization hurting patients, driving burnout and practice closures
American Medical Association President Bruce Scott, MD, explains the growing issues with insurance prior authorization impacting patient care and what the AMA is doing about it.
AMA to advocate for improved Medicare payments for office-based labs
SCAI and other healthcare groups want changes made to how healthcare providers are paid after performing office-based lab procedures. "As much as we love delivering care as doctors, if we are losing money doing something, we cannot sustain it," one cardiologist explained.
AMA President highlights growing crisis facing U.S. physicians
American Medical Association President Bruce Scott, MD, explains some of the key issues facing physicians, including burnout, growing medical staffing shortages, doctors leaving rural areas, increasing patients and declining Medicare payments.
Society of Interventional Radiology joins others in urging Medicare payment for high-cost disposables
The resolution urges the AMA to advocate for separate payment for certain services using supplies priced above $500, as well as those containing high-cost equipment.
Upcoding on the rise across all outpatient settings, study finds
A report by researchers at Trilliant Health found that common symptoms—such as cough, nausea and rash—are often coded as complex medical events, resulting in higher reimbursement rates.

PHOTO GALLERY from AMA House of Delegates 2022 meeting

Here are images from the American Medical Association (AMA) 2022 House of Delegates (HOD) meeting in Chicago, June 10-15. This was the first time the HOD met in two and a half years because of the COVID-19 pandemic.

Collecting Earned Revenue: How AI Maximizes Radiology Payments

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Today’s most pioneering radiology groups are using artificial intelligence to chase down payments, increase patient satisfaction, relieve front and back office workload, and recoup earned revenues.

FDA clears spinal-tap test that could challenge PET in Alzheimer’s diagnostics

The FDA has approved a lab test for evaluating cognitively impaired adults who may be in the early stages of Alzheimer’s disease.

Foot ultrasound bested foot MRI on pooled sensitivity while lagging on specificity

MRI beats ultrasound at grading common foot injury, but tables turn for up-or-down diagnostics

Injuries of the plantar plate—the cluster of ligaments underneath the four smaller “knuckles” of the toes—are better assessed with MRI than with ultrasound scans.

Major teaching hospital finds half its on-call abdominal ultrasounds call utilization into question

The investigators encourage radiologists to consider the numbers and take steps to “reinforce their gatekeeper function” to help cut ultrasound overutilization.

VIDEO: The importance of the Physician Practice Information Survey and its impact on radiology reimbursements

Linda Wilgus, CPA, CMPE, executive director and chief financial officer of Northwest Radiology Network and a past president of the Radiology Business Management Association (RBMA), explains the importance of the Physician Practice Information Survey CMS in calculating radiology reimbursements.

New York cardiologist charged for alleged involvement in COVID-related fraud scheme

He was charged with three counts of healthcare fraud for an alleged scheme involving office visits that never occurred.

Cardiologist’s legal fight against fraud conviction may be heard by Supreme Court

Kentucky cardiologist Richard Paulus was first found guilty back in October 2016, but he was granted a new trial in 2021.

Revenue & Reimbursement

AMA president warns prior authorization hurting patients, driving burnout and practice closures

AMA to advocate for improved Medicare payments for office-based labs

AMA President highlights growing crisis facing U.S. physicians

Society of Interventional Radiology joins others in urging Medicare payment for high-cost disposables

Upcoding on the rise across all outpatient settings, study finds