CMS kick-starting new radiology prior-authorization policies on July 1, imaging advocates

Good health of the people of the country leads to the accumulation of wealth as well. No country can ever shine without guaranteeing advanced medical care facilities for the population. Apart from making the advanced medical care facilities available, it is also important to ensure proper distribution of the services.

When the best facilities reach the most people, the aim of the medical care sector gets attained. The radiology lateral has emerged as one of the pillars of the health care sector. With its advanced procedures and technologies, radiology ensures a better diagnosis of several diseases. And who can deny that diagnosis is the very first step towards ensuring holistic health care and treatment?

The health care sector is a considerably big arena that encompasses plenty of laterals like hospitals, diagnostic centers, clinics, pathological units, medicine shops, etc. all these work hands in hand to lend the sector its accuracy and efficiency. If any of these fail to work optimally, the medical care sector’s entire functioning suffers, putting the future of several patients in danger.

Hence, the internal functioning of all these units must be flawless. Also, each one of these must maintain operational transparency with the other. With fair deals and transparent functioning, the medical care sector cannot maintain a volume it currently has assumed.

Interventional Radiologists

While the term radiologists generally offer us an idea of a person capable of taking interior body images to detect the organ-specific troubles we face. In no way is this description inadequate or untrue. But, there lies more to it for sure. Radiology is an ever-evolving branch of medical studies, and interventional radiology is just a specialized part of it.

We mean a specially trained physician who can run small surgeries using medical imaging techniques by interventional radiologists. Besides detecting the problem, these specialists can also cure your complications through these minimally invasive targeted treatment procedures.

What An Interventional Radiologist Do

Diagnosis is always the primary task that every variety of radiologists specializes in. However, the interventional radiologists are trained and equipped enough to go beyond this classic definition of radiology. These specialists conduct stent insertion, angioplasty, bursal injection, carotid stenting, image-guided liver biopsy, Carpal Tunnel Ultrasound and Injection, etc.

While some of these are basic, some are critical enough. To perform these specialized treatments, the interventional radiologists generally charge the clinic or organization in which he/she is performing the same. And here comes the point of discontent that has led to the latest switch of the norms that have so far ruled the market.

The Changed Scenario

The fresh thing around the medical care corner is the declaration of the radiology prior authorization policies, which are all set to be implemented from July 2020. While the policy was ready since last year, it found its way into effect a couple of days back.

These changes will apply to the Rapid Application Development practices (RAD) that offer interventional vascular and vein care in hospitals’ outpatient facilities. It was only the last month when most of the Medicare Administrative Contractors sending letters and correspondences regarding this switch. The Radiology Business Management Association confirmed the same in their Monday blog post.

The Policy

With the policy in place, the interventional radiologists will now have to seek prior approval for their image-guided procedures before billing CMS.  The policy provides eight separate image-guided procedures for which the interventional radiologists will have to get prior authorization.

The destruction of a vein in the leg or arm using chemicals, lasers, or radiofrequency is an example of such procedures. When The Centers for Medicare and Medicaid Services first approved this policy in 2019, it projected the same as a part of the final rule of the Ambulatory Surgical Center or the 2020 Outpatient Prospective Payment System.

The RBMA also mentioned that even though the rule came out last year, the letters will now trigger the curiosity of the interventional radiologists, as prior authorization is undoubtedly a hot button issue.

CMS further clarified that this policy aims at controlling the random increase in the number of these image-guided services in the recent past. Plenty of operations are done keeping the financial benefits in mind, and the same often becomes a burden for the patient. Also, random surgeries can be detrimental to the heath of the patient, as well.

Hence, CMS wants to confirm that all the surgeries that will take place from now on will have unavoidable grounds. The American College of Radiology has also come forward and made its members aware of the changes.

At sepStream®, we aim at offering you the best services at the right prices. We keep imaging services secure and advanced to match your demand. Our team of experts also makes sure that you do not have to avail of any services that you need the least. Hence, optimal medical care is what you can expect from us.