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    May 7-9, 2024
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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

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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-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

Updated 588 EFT enrollment form - Medicare Administrative Contractors will accept current and revised versions of the form through April 30, 2024. Starting May 1, 2024, you must use the revised form. 


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 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

March 8, 2024 UnitedHealth Group offers a timeline to restore ChangeHealth systems
Medical claims
: We expect to begin testing and reestablish connectivity to our claims network and software on March 18, restoring service through that week.
Many providers have had sucess filing claims by utilizing Optum Intelligent EDI (iEDI): A multi-payer web service and clearinghouse solution for all your EDI transactions. This service is free Learn more Here

March 6, 2024 Feds launch inquiry to assess private equity's impact on Healthcare
“When private equity firms buy out healthcare facilities only to slash staffing and cut quality, patients lose out,” FTC Chair Lina M. Khan said in a March 5 statement. “Through this inquiry the FTC will continue scrutinizing private equity roll-ups, strip-and-flip tactics, and other financial plays that can enrich executives but leave the American public worse off.”

March 5, 2024 Technologist files class action lawsuit claiming imaging provider violated labor laws
Plaintiff attorneys claim Digirad Imaging Solutions failed to pay minimum wages or overtime, along with shirking laws requiring regular meal and rest periods

March 5, 2024 Physicians urge HHS to tap emergency funds to help practices survive Change Health Cyber attack
Monday marked the 12th day providers have had to go without revenue due to disruptions at billing vendor Change Healthcare, the American Medical Association said March 4. This has placed an “enormous administrative burden” on medical groups, which have had to devise workarounds to submit claims, verify patient eligibility or obtain prior authorization.

March 5, 2024 Major data gaps persist as feds tackle Nursing Home Ownership transparency
Researchers continue to struggle to identify bad actors when approving changes in ownership or management, 

March 1, 2024 DOJ collects $1.9B from Healthcare in 2023 with Imaging Provider making one of the biggest payout

February 29, 2024 ALERT! Change Healthcare cyberattack having an ‘alarming’ impact on physician practices, advocates warn HHS
Since the issue first arose on Feb. 21, providers in radiology and other specialties have experienced “substantial” billing and cash flow disruptions and limited electronic remittance advice from health plans. The Medical Group Management Association is imploring HHS to help mitigate these issues and prevent practices from having to take “drastic actions” to remain in operation.


February 21, 2024 Cyberattack temporarily shuts down United Health's ChangeHealthcare
A U.S. healthcare IT power player, Change Healthcare, announced Thursday that an outside cybersecurity threat has forced the company to disconnect systems, causing worldwide outages that the company said might linger. 

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 22, 2024 Nursing Home Mogul Phillip Estformes pleads Guilty to Medicare fraud, given no additional jail time or fines.
The Department of Justice agreed to drop five other counts against him.

February 16, 2024 California Hospice physician convicted of $2.8M Medicare fraud

As medical director of Hospice, Dr. Thropay of California fraudulently certified Medicare patients of Blue Sky Hospice as having terminal illnesses that the patients did not have so that Blue Sky Hospice could bill Medicare for hospice services.

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.
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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

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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

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    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...

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    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...

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    $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...

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