How are imagers reimbursed for coronary CTA?

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Slim has been heavily involved in the reimbursement aspect as the SCCT representative on the American Medical Association (AMA) CPT panel and on the American College of Cardiology (ACC) Coding Task Force. . He is also a member of the board of the SCCT.

“A lot of us, when we went to medical school and residency, we didn’t get a lot of training or education about how we get paid and how do we get reimbursed for a new technology,” Slim said. “In my session, I wanted to demystify the process and help people understand how new technology is reimbursed.”

Having been involved in the process, he explains from experience how AMA CPT codes are developed, including the professional description of the services provided, the technical component to perform the service, and the collection of clinical evidence to show why the procedure or technology should be reimbursed based on improved patient outcomes.

It also explains the process and great importance of the Relative Value Scale (RUC) Update Committee survey, which is used to recommend Relative Value Units (RVUs) to Medicare and Medicaid Services Centers ( CMS). Slim said the RUC survey is sent to vendors to complete so they can explain the workload involved in performing the exam or service. This provides a basis for the value and payment resulting from review by CMS. This is the profession component of refunds. However, CMS refunds are often based on RUC surveys with a very low response rate as there is little point in spending time completing these paperwork involved.

The technical component of reimbursements includes the cost of the nurse, technologist, contrast, and other factors and supplies needed to perform the exam.

Technical and professional components can be combined in a global CPT billing bundle, or they can be separated. Slim said the professional component is often removed by hospitals when a study is read by an outside radiologist or cardiologist, who would bill the relevant professional separately.

Unfortunately, you learn all of that on the job,” Slim explained. “It’s a shortcoming for all of us. Societies and even medical schools don’t offer courses to explain this.”

He said this has become a problem as reimbursements decline and it is clear that more education is needed. “Regardless of all the advocacy efforts out there, if grassroots members of imaging societies don’t understand the elements they need to be successful, no matter how hard you advocate, that success won’t be accessible because the majority of people doing it don’t have the tools to do it right.This is an area where all medical schools and societies could do better.

Slim said it’s not just about getting paid for services provided, it also has an impact on patient care if doctors don’t understand the system or how to charge for it. “It’s not just self-fulfilling, because if we don’t do it right, we just get paid, it’s also for the patient,” he explained. “If we don’t do it right, patients won’t get the procedures they need.”

Complete information on the new codes is available on the WADA website.

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