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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An example of cardiac MRI myocardial blood flow reserve (MBFR) imaging. Image courtesy of https://doi.org/10.3390/diagnostics10090679

Imaging group thrilled with new CPT codes for MBFR measurements

The Society for Cardiovascular Magnetic Resonance applauded two new CPT Category III codes for myocardial blood flow reserve (MBFR) assessments.

American Society of Nuclear Cardiology (ASNC) 2024 President Lawrence Phillips, MD, FASNC, director of nuclear cardiology and medical director for outpatient cardiology at NYU Langone Health, explains ASNC’s advocacy efforts for Medicare payments and reform.

ASNC president advocates for Medicare reimbursement reform

Lawrence Phillips, MD, president of the American Society of Nuclear Cardiology, said that U.S. physicians are growing more and more frustrated by Medicare policies.

Melissa Chen, MD, Clinical Neuroradiologist, Associate Professor, University of Texas MD Anderson Cancer Center, said challenges ton radiology include the limitations of the relative value units (RVUs) used to pay radiologists, the need for balancing workloads despite disincentives to reading some studies, and the need to find new workflow efficiencies with AI to offset the radiologist shortage. #RSNA

Radiology at tipping point with limitations of RVUs and the growing shortage of radiologists

Melissa Chen, MD, MD Anderson Cancer Center, outlines some of the challenges practices are facing and possible solutions.

HeartFlow’s AI-powered CAD offering receives new CPT code with improved reimbursement rate

For this update to be finalized, the American Medical Association had to determine FFRCT Analysis met certain requirements in terms of its overall impact on patient care. John Farquhar, CEO of HeartFlow, described the news as "a win for everyone involved, most notably patients." 

Medicare money payment reimbursement dollar decline george washington

Cardiologists speak out about reimbursement cuts, say Congress ‘left clinicians holding the bag’

When Congress passed its latest continuing resolution to avoid a government shutdown, it provided no relief for cardiologists and other physicians impacted by ongoing Medicare reimbursement cuts. The American College of Cardiology responded to this development with yet another plea for change. 

Richard Heller, MD, RSNA Board member, associate chief medical officer for health policy and communications, and national director of pediatric radiology at Radiology Partners, explains some insurance companies are trying to take advantage of the No Surprises Billing Act by telling radiology practices they need to accept lower rates to remain part of the providers in-network.

Radiologists urged to report insurance companies forcing lower reimbursements due to No Surprises Act

Some payers are taking advantage of the NSA by forcing practices to accept lower rates to remain in-network, says Rad Partners' Richard Heller, MD. 

Video interview with Radiology Business Management Association (RBMA) President Kit Crancer, and executive director of the Rayus Quality Institute, where he said the lack of federal policy on insurance coverage for diagnostic breast exams as opposed to screening exams

State legislation addresses gaps in breast imaging coverage, ensures affordable diagnostic exams

RBMA President Kit Crancer said a lack of federal policy has driven 20 states to adopt laws requiring that insurance cover the costs. 

Video of Yousif Ahmad, MD, Yale, discussing IVL advances and increased reinbursements

Tracking key advances in intravascular lithotripsy

Yousif Ahmad, MD, spoke with Cardiovascular Business about the latest advances in IVL therapy, including new reimbursement changes for the technology. 

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