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Articles Posted in Diagnostic Imaging

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Pennsylvania Act 112 – Imaging Entities Now Required to Report to Patients on “Significant Abnormalities”

The Patient Test Result Information Act – commonly referred to as Act 112 – now requires Pennsylvania imaging entities to directly communicate with patients if the entity finds “significant abnormalities” in the patient’s test results, as well as to continue to follow normal reporting procedure to inform the ordering physician.…

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OIG Work Plan 2013

On October 3, 2012, the OIG released its Work Plan for the FY of 2013. Throughout the week, we will be posting on various aspects of the Work Plan pertinent to our clients and our readers in the following areas: • Hospitals • Home Health Agencies • Hospices • Evaluation…

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OIG Releases Report: Questionable Billing Patterns of Portable X-Ray Suppliers

The Office of Inspector General (“OIG”) recently released a report entitled Questionable Billing Patterns of Portable X-Ray Suppliers (“Report”) wherein it identified portable x-ray suppliers with billing patterns associated with inappropriate Medicare payments. As a result of its Report, the OIG made recommendations to the Centers for Medicare and Medicaid…

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Professional Component MPPR Will NOT Apply to Group Practices at This Time

As we reported in previous blog entries regarding the 2012 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (“CMS”) will be expanding its application of the Multiple Procedure Payment Reduction (“MPPR”) to the professional component (“PC”) of certain diagnostic imaging procedures. Currently, the MPPR only applies to the…

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CMS Expands MPPR to Professional Component of Advanced Diagnostic Imaging

On July 19, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule (“Proposed Rule”). On November 1, 2011, CMS issued its CY 2012 Physician Fee Schedule Final Rule (“Final Rule”), in part, to “address changes to the…

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CMS Issues 2012 Final Physician Fee Schedule

CMS Issues 2012 Final Physician Fee Schedule. On July 19, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule (“Proposed Rule”). On November 1, 2011, CMS issued its 2012 Final Physician Fee Schedule (“Final Rule”), in part,…

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MedPAC Recommendation for Reduction in Imaging Services is Being Met with Strong Opposition

The Medical Payment Advisory Commission (MedPAC) plans to release a recommendation calling for a reduction in the use of imaging services, including MRIs, CT scans and nuclear medicine. MedPAC’s advisory opinion would require some physicians and their patients to obtain pre-approval from Medicare for advanced imaging services. The proposal, if…

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False Claims Act Allegations Resulted in Florida Radiology Clinic and Others to Pay $3 Million Settlement

A Florida radiology clinic, Midtown Imaging LLC, and its former owners–Midtown Imaging PA and PBC Medical Imaging–have agreed to pay $3 million to settle allegations that Midtown Imaging LLC submitted false claims to Medicare between 2000 and 2008. The allegations arose from Midtown Imaging LLC’s lease and professional services agreements…

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Key Updates from the CMS 2011 Final Physician Fee Schedule

CMS’s 2011 Final Physician Fee Schedule (the “Fee Schedule”) provides for over 2000 pages of new rules and regulations pertaining to physician reimbursement under Medicare for 2011. With the passing of the Patient Protection and Affordable Care Act (“PPACA”) and the Healthcare and Education Reconciliation Act (collectively referred to as…

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OIG 2011 Work Plan: Diagnostic Testing

The OIG will review the high-cost diagnostic tests to ensure that they were medically necessary by looking at the same diagnostic tests ordered by the primary care physician as well as the specialist. With respect to independent diagnostic testing facilities (IDTFs), federal regulations require compliance with 17 standards. The OIG…