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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. MEMBERS ONLY-sign 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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February 16, 2024 RadNet launching career training to address Technologist shortage
The initiative comes as radiology providers face ongoing challenges hiring techs and other allied health professionals. Last year, the American Society of Radiologic Technologists reported that vacancy rates had hit record highs, including 18% among radiographers.

February 14, 2024 Inside the Rash of Abrupt Nursing Home Closures
“Until a couple years ago, CMS was reluctant to terminate SNFs and generally only did so as a measure of last resort,” he said. “That seems to have changed. 

February 13, 2024 Radiology errors rates unchanged in 75yrs - Can you see the Gorilla in the Image?
Per Radiology News, "We have to deal with this human factor. Good radiologists who are doing the right thing, who are knowledgeable, experienced, well trained, well rested, had their coffee, sitting the right chair, and their displays are bright enough, are still going to have a 3-4% error rate," 

February 6, 2024 Private equity-backed Premier Radiology inks long-term partnership with nation’s largest occupational health provider
“Handling thousands of patient scans daily requires a flexible system. Our advanced technological integrations ensure we always have the necessary resources, regardless of demand,” Drew Gaudet, co-founder and CEO of Premier Radiology, said Feb. 6. “This allows us to focus on providing targeted care to our occupational health patients quickly without being bogged down by technological concerns.”

February 2, 2024 Nursing Home Mogul Philip Estformes agrees to Plea Deal in Medicare Fraud Case
However, he is required to pay $5.5 million in restitution to the taxpayer-funded Medicare program. Additionally, he must pledge at least $14 million in assets towards his outstanding forfeiture penalty of $38.7 million 

February 1, 2024 Radiology embracing the flexibility of Cloud Image Storage
Radiology is navigating towards cloud and enterprise imaging solutions to overcome IT challenges and unlock new possibilities for workflow efficiency, research, artificial intelligence and ultimately improve the quality of patient care. 

February 1, 2024 CMS signals Medicare Advantage cuts in 2024
Medicare Advantage insurers could face an average 2.3% cut to baseline payments in 2024, the Biden administration said Wednesday. If the proposal stands, it would be a net cut of more than $3 billion to the industry.

January 31, 2024 Radiology at tipping point with limitations of RVUs and shortage of Radiologists
Is RVU still a good measure? How many reads in a day are too many? Can AI help? 

January 30, 2024 Hospice Fraud back in the Spotlight with Home Health Agencies right behind
In one instance last year, 15 new hospices received Medicare certification, all operating from the same two-story building in Los Angeles, according to Pro Publica.The numbers point to something similar possibly happening in the home health industry.....

January 29, 2024 Layoffs Hit At-Home Care Innovator Dispatch Health

January 23 2024 OIG to audit CMS oversight of State contracted Nursing Home Surveyors
“It’s no secret that states are struggling to conduct surveys quickly and effectively,” Blackman and Muncy told McKnights in a written comment. 

January 19, 2024 How the Chevron Case gives providers a chance to pick their poison - Federal agencies or Courts to have final say in interpretation of regulations. 
In a nutshell, the High Court is going to let us know whether administrative agencies like CMS will continue to have the final say on what goes into legally binding regulations and how they’re enforced, or whether the courts should take more of that responsibility.

January 17, 2024 Billionaire Mike Bloomberg puts up $250 Million to open Healthcare High Schools for training Radiologic Technologists
Each location will offer robust academic programming, specialized healthcare classes, work-based learning at partner hospital systems, and a chance to earn necessary certification.

January 17, 2024 CMS to streamline prior authorization process that has plagued Radiology
Under the rule, CMS will require health plans to issue decisions on whether a service is covered within 72 hours for urgent requests and seven days for other standard claims. Beginning in 2026, the agency also will mandate that payers provide a specific reason for denying a prior authorization request. CMS additionally will require insurers to publicly report metrics on their denial of coverage for imaging and other services.

January 16, 2024 Medicare Advantage spending outstrips traditional Medicare by $88B
The federal government could pay Medicare Advantage plans $88 billion more this year than it would be spending if those seniors were in traditional Medicare, according to new data from congressional advisory group MedPAC
.

January 11, 2024 New Jersey Lab pay $13M to settle kickbacks and unnecessary testing
RDx and Leykin allegedly paid commissions based on the volume and value of Medicare and Medicaid referrals to independent contractor marketers to arrange for and recommend that healthcare providers order RDx laboratory tests.

January 11, 2024 Portable X-ray provider sentanced to 15 years prison, $1,989.490 in restitution for Medicare fraud-appeal denied
The owner of a portable X-ray business has lost an appeal after arguing that his 2022 conviction should be tossed over the jury’s COVID-19 vaccination status

January 5, 2024 Errors in imaging orders - the burden of incorrect orders
“Combining tailored order options in the [electronic health record] with education and feedback on practice habits can improve the accuracy of imaging orders, thereby mitigating the overall order error rates,” Ariadne K. DeSimone, MD, a cardiothoracic radiologist with Brigham and Women’s, and co-authors wrote Jan. 2.

January 4, 2024 Effective January 1, 2024 Lab speciman fee gets an increase

January 3, 2024 New Federal Initiatives increase criminal enforcement concerns for SNFs & Providers
The White House announced in December it would be launching a cross-government public inquiry “into corporate greed in healthcare.” It includes the addition of new, high-ranking healthcare attorneys at three federal agencies with healthcare oversight.

December 21, 2023 Study: Hospital at Home May Relieve Caregiver stress

DispatchHealth has published findings from a case study assessing caregiver fatigue within the hospital-at-home model, and they suggest that in-home hospital alternative care may alleviate, not exacerbate, caregiver stress.

December 28, 2023 Medicare Advantage growth raises critical financial concerns
While MA plans cost the government 6% more per enrollee as opposed to traditional Medicare, MA continues to underpay providers

December 14, 2023 Congress adjourns for 2023 without a Radiologist pay fix
Key congressional committees had recently advanced legislation to offset a nearly 3.4% cut to the conversion factor next year. However, it appears the full House and Senate will not vote on a doc Medicare pay fix before the year’s end.

December 14, 2023  Radiologists lose market share of Medicare ultrasound billings to cardiologists in some settings
Radiologists have lost a substantial share of the ultrasound billing market in certain sites of service over the last decade while cardiologists have gained ground, according to new research.

December 13, 2023 White House announces plan to scrutinize private equity ownership in healthcare

Officials highlighted “roll-up” acquisitions, which “currently evade antitrust review,” as one area of concern. Businesses such as private equity firms and health insurers often use this strategy, which involves making a series of small acquisitions that can eventually lead to the consolidation of a market.

December 12, 2023 US Supreme Court Denies Nursing Home Operator, Phillip Estformes appeal hearing to throw out conviction & Penalties

Nursing home operator Philip Estformes – convicted of one of the biggest Medicare frauds in history....was denied an appeal hearing by the U.S. Supreme Court on Monday to throw out his conviction altogether.
December 8, 2023 House lawmakers pass bill to blunt Radiology cuts
On Thursday, House Energy & Commerce announced it has advanced a package of healthcare-related bills out of committee. The list included H.R. 6545, the “Physician Fee Schedule Update and Improvements Act,” which incorporates a 3% increase to the conversion factor to offset the 3.4% planned cut.
December 7, 2023 Platform allowing patients to second guess their Radiologist reading expands to 12 states
MDView first launched in its home state of Florida over the summer and is now ramping up its roll out. As part of the announcement, the Cooper City-based tech company has inked a new partnership with Modern Teleradiology to provide second opinion reports and video consultations to its users.

December 5, 2023 New Ultrasound system facilitates catheter and IV placement
The BD Prevue™ II Peripheral Vascular Access System reportedly offers real-time needle depth markers that may reduce multiple needlestick attempts and allow easier placement of intravenous (IV) access in high-risk patients. Learn More
November 29, 2023 Medicare Advantage: A not so advantageous deal for Beneficiaries and Providers

The Centers for Medicare & Medicaid Services has been notoriously laissez-faire when it comes to Medicare Advantage, likely due to the revolving door between CMS and the insurance industry

November 30, 2023 Growing shortage of Radiologists and Technologist and overutilization of unnecssary exams was the biggest topic discussed at RSNA meeting this week

"The large volume of wasteful procedures is impacting patients in bad ways. We are exposing people to radiation, there is a greater fraction of false positives that then lead to over treatment and over diagnosis, the cost is staggering, and we are frankly running up against a limitation of our capacity. Especially after the great resignation, we simply don't have enough manpower to keep up with this," Bruno said. 

November 16, 2023 Visiting Nurse Health System partners with Dispatch Health


November 15, 2023 California SNFs owner and management agree to a $45.6M consent judgement to settle allegations of kick backs from Referring physicians
From 2009 to 2021, the SNF Defendants, under the direction and control of Thekkek and Paksn, systematically entered into medical directorship agreements with physicians that purported to provide compensation for administrative services, but in reality were vehicles for the payment of kickbacks to induce the physicians to refer patients to the six SNFs

November 15, 2023 CMS releases final rule for Transparency of Nursing Home Ownership
The final rule requires nursing homes enrolled in Medicare or Medicaid — the majority of this country’s nursing homes — to disclose additional information regarding their owners, operators, and management; for example, nursing homes will disclose individuals or entities that provide administrative services or clinical consulting services to the nursing homes. Nursing homes will also be required to disclose entities that exercise financial control over the facility, such as an organization the nursing home hires to manage all of its financial matters.

November 7, 2023 CMS' Goal to Enroll all Medicare Beneficiaries in ACOs by 2030. 

November 6, 2023 Occupancy for SNF's increasing-Optimistic Economic Outlook

Occupancy for skilled nursing facilities (SNFs) increased nationally by 40 basis points month-over-month through October 22, 2023, following a prior increase of 15 basis points, according to BMO Capital Markets’ analysis on SNF REIT occupancy data for October.


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Registration Now Open
2024 Capital Hill Fly-In 

May 7th - 9th, 2024
Everyone is welcome to Register!
members, portable diagnostic stakeholders, associate business members, vendors

IMPORTANT DATES: 
Effective January 1, 2024 The Corporate Transparency Act requires filing by January 2025-consult your attorney or accountant-Read More

Effective January 1, 2024 the Medicare enrollment application fee is $709 for institutional providers 


KEY UPDATES TO PROVIDER ENROLLMENT PROGRAM INTEGRITY MANUAL effective 1/1/2024 read More Members Only -login & go to Resources Tab


NEW RULE FOR MED. ADVANTAGE effective 1/1/2024 read More Members Only-login & go to Resources Tab

855R Form is discontinued as of November 1, 2023 and is incorporated into 855I​

October 2023-Revisions to IDTF Learn more Members Only-login & go to Resources Tab
NEW ABN FORM CMS R-131 - START USING 6/30/23 read More Members Only-login & go to Resources Tab


Important Dates for Reporting

 LEARN MORE

Reporting Period 5 Is Closed

Recipients who received one or more PRF and or ARP payments exceeding $10,000, in the aggregate, during a Payment Received Period are required to report in each applicable Reporting Period as outlined below.

Payment Received Period (Payments Exceeding $10,000 in Aggregate Received) Period of Availability for Expenses Period of Availability for Lost Revenues  Reporting Time Period
Period 6 July 1, 2022 – December 31, 2022 January 1, 2020 – December 31, 2023 January 1, 2020 – June 30, 2023 January 1, 2024 – March 31, 2024
Period 7 January 1, 2023 – June 30, 2023 January 1, 2020 – June 30, 2024 January 1, 2020 – June 30, 2023 July 1, 2024 – September 30, 2024
Period 8 July 1, 2023 – December 31, 2023 January 1, 2020 – December 31, 2024 January 1, 2020 – June 30, 2023 January 1, 2025 – March 31, 2025

 
 

Blog

  • Blog Article Image

    Transportation for Sono-EKG

    • Wednesday, March 14, 2018
    • Admin

    BRIEF Only a fraction of the EKG and ultrasound tests paid for by Medicare are performed outside of physicians' offices or hospital settings and, thus, are potentially affected by the payment policy changes. In 1995, Medicare paid approximately $597 million for 14 million EKGs...

    Read More »
  • Blog Article Image

    Portable Diagnostics Touching Lives - Rene's Mother

    • Wednesday, March 14, 2018
    • Admin

    Rene's Mother Rene Steven of Wichita, Kansas is grateful for the many services that portable diagnostics have been able to provide her mother, Esther Steven. At 91, Esther is truly remarkable. After raising 11 children, she has been blessed with numerous grandchildren and great...

    Read More »
  • Blog Article Image

    $18 Billion in Cost Avoidance - The Math Behind the Number

    • Wednesday, March 14, 2018
    • Admin

    Overview: The stated goal of Patient Protection and Affordable Care Act (PPACA) (i.e. Obamacare) and Health Care Reform is what people like to call the Triple Aim. As you know, the Triple Aim was designed to: Improve patient satisfaction and quality of care Improve...

    Read More »