Increase Your Medicare Reimbursement with These Two Timely Tips

The forecast is in for medical service reimbursement, and it proves that providers need a sound strategy going forward.

Over the past twenty years, medical imaging has suffered the most of all medical services in terms of both cost and reimbursement. The cost of medical imaging grew much quicker than that of most other medical services did during recent years, preventing providers from both providing medical imaging exams and from purchasing new equipment (ACR, 2012).

Several studies have linked imaging examination with a wealth of positive benefits, such as longer life expectancy, declines in mortality, less need for exploratory surgery, and fewer hospital admissions (ACR, 2012).

In an effort to save money in the short-term, what are we giving up in the long-term by postponing medical imaging services?

We could see a reversal of its benefits, worst-case scenario. The immediate savings that insurance sees from slashing reimbursements might actually result in much larger cost increases later.

“Insurance companies are trying to save money by limiting utilization and lowering reimbursements, when in fact, they’re costing themselves more money downstream,” Breda Drury, former radiology director and clinical specialist at Novarad, said.

However, there is good news.

No matter what the end result is, there are ways to help ensure that your practice receives the highest amount of compensation from the government. It just involves a little “playing by the rules.”

Two of your greatest defenses against low reimbursement are radiation dose software and clinical decision support.

If you haven’t already, install radiation dose monitoring software.

It isn’t enough to leave your radiation dosing simply to a dosing method. Many older machines can’t keep up with contemporary radiation dose requirements, and with the onset of the new Joint Commission standard last July, there will be penalties coming down the line for providers who do not comply.

Providers who don’t comply with the regulation will be hit hard in the next couple years in the reimbursement department. In 2016, non-compliant providers will face a five percent reduction in reimbursement for radiation procedures.

By 2017, non-compliant providers will face a 15 percent reduction in reimbursements.

Avoid this by installing radiation dose management software that complies with Joint Commission requirements. Rather than missing out on reimbursement, it is less costly for providers to ensure that they meet requirements. Novarad offers its NovaDose radiation dose management software solution with options for any size facility. You can learn more about it here.

Get an early edge on clinical decision support.

Reasonable clinical decision support is, as of now, difficult to find and can be incredibly cost-prohibitive, although Novarad is working around the clock to find you an affordable option. One alternative suggested by Breda Drury, former radiology director and clinical specialist at Novarad, is building custom alerts and checklists into your radiology information system.

“I was consulting for an ophthalmology practice, and they noticed that their Medicare rates were dropping,” Drury said. “[At that point], their key payer was Medicare. We were navigating through a Medicare reimbursement, and they would pay for these patient visits based on the quality of care that was delivered.”

“The quality of care consisted of what they did and what ranges they came up with. Based on that, we worked with the EMR company and the ophthalmology techs to customize fields and alerts that were built into the software. An alert would come up to let us know if we weren’t hitting all of those care points.”

If you would like help or advice in setting up checks for your own facility, Novarad is more than happy to help you. Get in touch with a specialist here.

It can seem like getting full reimbursement is a constant battle—and in a way, it is. Ultimately, however, doing your best to stay on top of them is all you can do. Keep your eye on our blog, subscribe to our email list, and follow Novarad on social media to stay informed.


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