Reimbursement for diagnostic imaging services has been in the crosshairs at the Centers for Medicare & Medicaid Services (“CMS”) for as long as the health care cost curve has been bending upwards. Despite recent findings that imaging is currently near the bottom of the drivers of growth in Medicare spending, the 2014 Hospital Outpatient Prospective Payment (“HOPPS”) Final Rule has been controversial for once again cutting imaging reimbursement for Medicare patients.
At the heart of the issue is CMS choosing to use CT and MRI cost center specific information in calculating reimbursement amounts for those modalities. Historically, reimbursement was set using inputs from all radiology and imaging departments in aggregate. The HOPPS proposed rule estimated the associated reductions in CT and MRI reimbursement at 38% and 19% respectively. Industry experts correctly pointed out to CMS some of the flaws under the proposed methodology and the final rule issued late last year reflected a modified approach that only reduced reimbursement for CT by 21% and MRI by 12%.