Written by Block Imaging CLICK HERE to go to the ORIGINAL SOURCE
Jun 13, 2014 3:34:00 PM
On April 1, 2014, the president signed into law the Protecting Access to Medicare Act of 2014 (HR 4302). Beginning in 2016, Medicare will pay less for certain diagnostic CT scans performed on CT equipment that does not meet the XR-29 CT standard (MITA Smart Dose) .
What does this mean for you? For some, not a lot. Your CT may already meet the requirements or only need a field upgrade. For others, this legislation could mean replacing your system altogether or facing the applicable reimbursement cuts. To help you get a better idea of where you fall on the spectrum, we’ve taken a closer look at the law and the penalties below.
System attestation by providers will be verified through the periodic supplier accreditation process (e.g. Joint Commission, ACR, IAC, etc.). The CT dose standard is applicable to CT-designated HCPCS codes in which the payment source originates from the Medicare Physician Fee Schedule (PFS) or the Hospital Outpatient Prospective Payment System (HOPPS or OPPS).
You can read the legislation for yourself if you have the time. All 45 pages of it are available here.
If you’d rather not read the whole thing, maybe read just the portion applicable to your concerns. In Title II, Section 218, congress amended Section 1834 of the Social Security Act by adding a portion titled “Quality Incentives to Promote Patient Safety and Public Health in Computed Tomography.” This section of legislation applies to the following HCPCS codes:
The legislation refers to your CT scanner and its consistency with the “CT equipment standard” as they define it. In short, if your CT scanner does not meet each of the attributes of National Electrical Manufacturers Association (NEMA) Standard XR-29, your reimbursement under the above HCPCS codes will be reduced by 5% for 2016 and by 15% for 2017 and beyond.
For these examples, we’ll calculate with 2014 reimbursement rates– just keep in mind they will likely change between now and January 2016 when the penalties would begin to apply.
HCPCS code 70488 (CT maxillofacial without and with dye) is currently reimbursed at $302.70 per scan. If your CT scanner does not meet the XR-29 requirements in 2016, this reimbursement would be cut to $287.56. If your CT scanner does not meet XR-29 in 2017 and beyond, the reimbursement rate would be $257.29.
HCPCS code 72125 (CT neck spine without dye) is currently reimbursed at $197.38 per scan. If your CT scanner does not meet the XR-29 requirements in 2016, this reimbursement would be cut to $187.51. If your CT scanner does not meet XR-29 in 2017 and beyond, the reimbursement rate would be $167.77.
Are these significant decreases? Yes. But are they enough of a decrease to make you rush out and spend hundreds of thousands of dollars on a new CT scanner?
It is our recommendation that you do some analysis and see what the cuts will actually do to your bottom line before you purchase a new CT scanner. It might be financially feasible to spend $50,000 less to get a machine that is not XR-29 compliant (GE Ultra 8) than one that is (GE VCT 32). If you decide that you can’t afford to lose out on that 15%, then it is wise to discuss your CT options with us here at Block Imaging. We will be able to help you decipher which features you must have and which features are, perhaps, beneficial but not essential to get you into a system that is XR-29 compliant at a fraction of the cost of new. We’ve done it before. We can do it for you.
Written by David Harns
David Harns is the CT Product Specialist at Block Imaging. His goal is to provide people with service that makes the experience of purchasing imaging equipment worry-free. Outside the office, David follows Michigan State University athletics closely. He also loves to travel with his wife and four sons — including to their favorite destination: Camp Arcadia on Lake Michigan.