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Reduction in Payment for Film X-Rays

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Tuesday, August 30, 2016

I absolutely love those television shows of people viewing and buying houses. One doesn’t have to watch many such shows to realize that people have very different taste in the types of houses they prefer. Some like brand-new, sleek and modern homes; some like more traditional homes; and others have a preference for vintage homes with character. But where is the line between “vintage” and just plain old? This distinction may also be applied to other products, items or aspects of our lives – for example, are film x-rays vintage or just old? However you view x-rays (pun intended), film and even computed radiography x-rays are out-of-date. Healthcare payers do not like to pay for out-of-date technology, especially when a newer technology provides more effective and efficient healthcare. As far as x-rays go, we now live in a digital world.

In the 2017 Outpatient Prospective Payment System (OPPS) proposed rule, CMS, in accordance with the Consolidated Appropriations Act of 2016, is proposing to reduce payments for film x-rays. Effective for services furnished during 2017 or any subsequent year, the payment under the OPPS for imaging services that are X-rays taken using film shall be reduced by 20 percent. CMS is also proposing that these services be identified by the use of a new modifier to be appended to imaging services that are X-rays taken using film. The presence of the modifier will result in a 20% reduction in the payment rate for the imaging service. This payment reduction is not considered an adjustment and will not be budget neutral.

For CYs 2018 through 2022, OPPS payments for X-rays taken using computed radiography will be reduced by 7%. Beginning in 2023 and thereafter, this reduction will be increased to 10%. CMS states that they will address the mechanisms for the reductions in OPPS payment for imaging services that are X-rays taken using computed radiography technology (including the imaging portion of a service) in future rulemaking.

The days of attaching a floppy film to an x-ray viewer are behind us or at least not worth what they once were. Marcus Welby, M.D. – you are out-of-date … or maybe vintage.

Article Author: Debbie Rubio, BS MT (ASCP)
Debbie Rubio, BS MT (ASCP), was the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.