• APDA ANNUAL 2024 CONFERENCE
    November 10th-13th, 2024

    Hotel Kansas City
    1228 Baltimore Ave. 
    Kansas City, MO 


    DON'T MISS THIS....REGISTRATION NOW OPEN!

  • APDA
    Our Mission & Who we Are

  • JOIN APDA POLITICAL ACTION COMMITTEE TODAY!

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THANK YOU CAPITAL HILL FLY-IN PARTICIPANTS

APDA members, portable diagnostic stakeholders, & associate business members completed at least 115 successful meetings with their legislative offices on May 7th - 9th. Participants shared their stories advocating for policy changes that will better serve our seniors-demonstrating the necessity of bedside Ultrasound & the need for providers to receive transportation cost reimbursement in order to continue this service that is so valuable to our bedridden elderly.
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TAKE ACTION! JOIN APDA PAC

We ask for your help in making noise on the Hill to EDUCATE our representatives and the healthcare industry on Portable Diagnostics and its value (avoiding unnecessary hospital visits by bringing x-rays & diagnostics to the elderly-saving lives & money)ADVOCATE for fair and equal transportation reimbursement for ALL states and PUSH for Fair inclusion in policies that matter to our patients & industry. 
  

OUR MISSION AND WHO WE ARE

Watch a short Video HERE about APDA
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ARE YOU CODING THE PLACE OF SERVICE CORRECTLY? PAY ATTENTION! OIG has released a report on an audit they conducted on 5/30/23 finding that providers are not using the correct place of service code when filing for the professional component for a PartA patient. CMS has been instructed to create edits to track these overpayments and request recoupments. 
EFFECTIVE MAY 30, 2024, Medicare has designated a "Stay of Enrollment" -rejecting any claims billing during the stay due to non compliance in Enrollment reporting- See- MEMBERS ONLY-log in and go to the Resources tab/Medicare for full report. 


APDA'S WORK FOR ITS MEMBERS AND THE INDUSTRY CONTINUES TO PAY OFF!
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April 2024-
Updated MLN-Medical Record Documentation requirements
MLN Fact sheet updated April 2024. What type of documentation is required? What are the repercussions of not having proper documentation? What are medical record retention best practices? What are signature requirements? - For Members Only - Log in & go to Resources tab/Medicare for answers

July 19, 2024 Information Blocking rule may require imaging providers to make available preliminary/immediate diagnostic reports to patients. 
“Now it is not uncommon for patients to have immediate access to their written radiology reports.

July 11, 2024 Three Clermont Labs Agree To Pay $2.45 Million To Settle False Claims Act Liability For Manipulating Diagnosis Codes

July 10, 2024 Clinical laboratory testing implicated in National Healthcare Fraud sting
The government now uses sophisticated data analytics to rewrite the fraud fighting playbook, essentially monitoring billing trends, identifying aberrant providers, and helping prosecutors spot emerging schemes,

July 9, 2024 Provider of in-home imaging and 24/7 Radiologist access raises $200M

Based in Nashville, Tennessee, the company is focused on physician-led care for vulnerable patients who cannot travel to a traditional healthcare facility. HarmonyCare Diagnostics brings the latest digital X-ray technology to patients’ homes or long-term care facilities, offering rapid results with board certified radiologists “available 24/7.”

June 13, 2024 Bipartisan Bill introduced to prevent Medicare Advantage plans from delaying Care

Prior Auths & inappropriate denials are #1 burden identified by healthcare providers. Specifically, the bill would Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.Increase transparency around MA prior authorization requirements and its use.

June 12, 2024 Congress reintroduces radiology bill aimed at curbing prior authorizations
Providers have cited prior authorization as their No. 1 administrative burden, a recent study found. About 3 out of 4 Medicare Advantage enrollees are subject to unnecessary care delays stemming from such utilization management, Marshall and colleagues noted

June 10, 2024 Teledoc Guidewell executive as new CEO

May 28, 2024 AHA & other national associations send letter to FTC urging delay of non complete rule

May 24, 2024 Providers affected by ChangeHealth breach ask HHS to reassure them that ChangeHealth will take accountability to perform appropriate Breach notification to the consumers


May 23, 2024 The Department of Justice’s (DOJ) Antitrust Division created a new task force to examine collusion and monopolies in the healthcare industry.

May 22, 2024 Growing trend of Radiology groups dropping Medicare Advantage
 Contracts

A Nebraska radiology provider is joining a growing number of institutions refusing to accept Medicare Advantage, contending that the privatized plans are “bad for patients” and taxpayers
"We're having real issues with some of our Medicare Advantage programs, where we have contracts in place to pay us one rate and they're paying us a rate much less than that," CFO Dan Morissette said during the health system's Feb. 29 investor call.


May 10, 2024 Conneticut Physician sentenced to prison for 5 year scheme ordering medically unnecessary transcranial doppler studies 
......Salzberg conspired with a principal for a medical diagnostics company that performed transcranial doppler (TCD) scans – brain scans that measure blood flow in parts of the brain – to order hundreds of medically unnecessary TCD scans in exchange for kickbacks.

April 26, 2024 MGMA wants Change Health to take responsibility for HIPAA violations

MGMA has sent a letter to the Department of Health and Human Services' Office for Civil Rights seeking clarity on whether providers or Change Healthcare will be responsible for alerting affected patients that their personal health information may have been compromised. Read More

April 25, 2024 Blue Shield slashes TC & PC Radiology reimbursement with new policy to take effect May 1, 2024

BS implements 50% reduction on the Technical component & 5% reduction on the professional component of multiple radiology exams performed on the same patient in one healthcare encounter

April 24, 2024 FTC bans most non-complete clauses 

The Federal Trade Commission issued a final rule on Tuesday banning noncompete clauses in most employment contracts, a move that drew praise from radiologists and other physicians.
About 30 million U.S. workers (or 18%) are covered by such agreements, aimed at reducing unfair competition and the spread of trade secrets. The FTC claims that curtailing noncompetes will lead to a 2.7% uptick in the formation of new businesses each year.

April 23, 2024 Overtime Rule to increase compensation thresholds for eligibility is finalized 

Effective July 1, 2024, the salary threshold will increase to the equivalent of an annual salary of $43,888 and increase to $58,656 on Jan.1, 2025.

April 22, 2024 Change Healthcare has up to 60 days to report a breach

Change Healthcare has not filed a breach, yet it claims patient data was compromised. Covered entities have up to 60 calendar days from the date of discovery of a breach of unsecured protected health information to file breach reports to OCR’s breach portal for breaches affecting 500 or more individuals. Covered entities that are affected by the cyberattack involving Change Healthcare and UHG are required to file breach notifications. Learn more 


April 22, 2024 United Health paid ransom to bad actors, says patient data was compromised in cyber attack
UnitedHealth, which has more than 152 million customers, said it has also determined that the cyberthreat actors accessed files containing protected health information and personally identifiable information, according to a release Monday. The files “could cover a substantial proportion of people in America,” the release said.

April 19, 2024 Update on Change Healthcare Cyber incident

OCR reminded all of these entities of their HIPAA obligations to have business associate agreements in place and to ensure that timely breach notification to the Department of Health and Human Services (HHS) and affected individuals occurs.

April 12, 2024 Overtime rule review completed by White House

The Labor Department had announced its proposal for a new threshold for overtime pay eligibility in August. Under the proposal, most salaried workers earning less than $1,059 per week, or about $55,000 per year, would be eligible for overtime pay. 

April 11, 2024 CMS New TEAM payment Model covers Nursing Home stays but Hospitals are in the driver's seat. 

The Centers for Medicare & Medicaid Services (CMS) is testing out a payment model that would cover all costs associated with an episode of care, including a skilled nursing stay, but it appears that select hospitals would be in the driver’s seat if approved. Hospitals will be responsible for the cost of care for the first 30 days......how will that work with ancillary services??

April 11, 2024 Small practices left vulnerable after ChangeHealth Cyber attack, with some considering Bankruptcy


April 10, 2024 Investigation reveals UHC, Aetna, Cigna made millions in fees from out of network claims

Major insurers made millions in fees by using MultiPlan, a data analytics firm, to determine how much to pay providers for out-of-network claims, according to an investigation from The New York Times. MultiPlan helps plans handle out-of-network claims, advising insurers what to pay providers. According to the Times, the plans often pay much less than providers bill — and charge self-funded employers a percentage of the savings as a processing fee. The formula incentivizes payers to pay providers less so they can charge employers higher fees. Meanwhile, patients are potentially responsible for the remainder. 

April 9, 2024 Lawmakers urge feds to closely scrutinize UnitedHealth Group Acquisition of Multistate Radiology Provider

UHG’s Optum subsidiary recently revealed its intent to buy Dallas-based Steward Medical Group, which spans nine states and 450 practices, employing 1,700 providers. Both U.S. senators, and the entire Massachusetts delegation, on Monday asked the Federal Trade Commission and Department of Justice to carefully consider the ramifications of the deal.

April 5, 2024 MedStart Health and Dispatch Health Launch acute care at home partnership

MedStar will connect patients with DispatchHealth based on clinical needs and geographic information before they are discharged. Medical treatments provided by DispatchHealth include labs, EKGs and IV fluids and medications.

April 4, 2024 "Health over Wealth" Act -
The bill would require greater transparency in healthcare entity ownership and put safeguards in place to protect physicians while preserving access.
"Recent studies find that the quality of patient care in hospitals and nursing homes goes down when PE enters the picture. Patients have a right to know who owns their health provider, especially if the owners don’t care about their health."


March 29, 2024 Radiology Group must pay $3.1M to settle allegations that Radiologists rubber stamped Radiology reports from India
Per Radiology Busienss News: An Atlanta-based teleradiology firm has agreed to pay $3.1 million to settle allegations it improperly billed the government for work handled by contractors in India that certain physicians merely “rubber-stamped.”Radiologists would spend as few as 30 seconds reviewing reports prepared by overseas readers who weren’t permitted to practice medicine nor bill government healthcare programs, authorities charge.

March 28, 2024 Providers get another valuable tool to help cope after ChangeHealth Cyber attack
The US Department of Health and Human Services released a list of national payer contact information, links to resources and information on advanced payments Monday. The aim is to give providers consolidated access to the resources they need to navigate the still-ongoing effects of the cyberattack, officials said. 

March 26, 2024 Radiology the only category to see decrease year after year in insurer's maximum allowable amount

March 20, 2024 RSNA launches new open-access medical journal - no subscription fee
Available exclusively online, Radiology Advances will cover a wide variety of imaging topics, all without a subscription fee. Its studies will focus primarily on emerging topics and innovative research, with radiologist Susanna I. Lee, MD, PhD, serving as editor.

March 19, 2024 HHS seeks input from payers on Change cyberattack response

March 18, 2024 Change Healthcare reaches "important" step in resumption of services
The billing vendor began releasing medical claims preparation software on March 18. UHG called this an “important step in the resumption of services,” noting that software use will be made available to “thousands of customers over the next several days.”

March 12, 2024 CMS offers advance payment to providers affected by ChangeHealth cyber attack



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APDA  43rd Annual Conference & Expo
November 10th-13th, 2024
Hotel Kansas City
Kansas City, MO