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Related Experiment Videos

Reimbursement update: looking toward the 1990s.

J Kisslo1, D S Millman

  • 1Department of Medicine, Duke University Medical Center, Durham, NC 27710.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|March 1, 1990
PubMed
Summary

Medicare carriers are applying radiology fee schedules to echocardiographic services, even when performed by non-radiologists. This impacts billing practices and reimbursement for these diagnostic imaging procedures.

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Area of Science:

  • Medical billing and reimbursement policies
  • Diagnostic imaging services
  • Healthcare economics

Background:

  • Medicare carriers are inconsistently classifying echocardiographic services.
  • Some carriers treat all echocardiographic billings as radiologic.
  • Multispecialty practices with radiologists are also affected by this classification.

Purpose of the Study:

  • To analyze the implications of Medicare carriers classifying echocardiographic services as radiologic.
  • To highlight the discrepancy in billing practices for echocardiographic services.
  • To examine the financial impact of applying radiology fee schedules to non-radiologist-provided echocardiography.

Main Methods:

  • Review of Medicare carrier decisions regarding echocardiographic billing.

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  • Analysis of fee schedule application for diagnostic imaging services.
  • Comparison of billing practices across different provider types.

    • Main Results:

    • Echocardiographic services are being billed under radiology fee schedules.
    • This occurs even when services are not performed by radiologists.
    • Inconsistent classification by Medicare carriers leads to non-uniform application of fee schedules.

    Conclusions:

    • The current Medicare billing practices for echocardiography are inconsistent and potentially inequitable.
    • Radiology fee schedules are being applied inappropriately to non-radiologic services.
    • Further clarification and standardization of billing policies for echocardiographic services are needed.