Essay Example on The introduction of 3D mammography

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The introduction of 3D mammography was an exciting advancement for breast imagers radiologists and patients alike Since FDA approval in 2011 the technology has proven itself time and time again In the midst of evolving CPT codes breast imagers are constantly required to adapt to the ever changing payer and workflow challenges The apprehension over whether or not an issuer will pay for mammography services is felt throughout an entire practice Education while challenging is key to understanding documentation billing and compliance requirements to thwart repeated claim denials Without proper support staff to train and educate physicians may not be reimbursed for the level of service they provided In years past physicians relied heavily on their billing staff or managers to take care of claim submission and many times there was a definite division of responsibility Physician technologists are trained to think clinically whereas secretarial and front staff are most often trained for administrative tasks But in recent years understanding billing coding and compliance has become the responsibility of the entire staff secretarial technical physician and billing Documenting patient reports records to include all required elements for specific CPT codes is essential Now more than ever it s become increasingly important for physicians to partner with their entire staff to ensure they are being reimbursed appropriately for their services Medicare publishes yearly CPT updates with the Final Rule Determination typically released in November with anticipated changes effective for January 1 However it s not uncommon for the announcement to include a notice that the expected proposed changes have been delayed For example with the addition of 3D mammography 



The Centers for Medicare and Medicaid Services CMS originally announced that it would adopt the new CPT coding as of January 1 2017 However when the final rule was released in late November 2016 CMS announced that it would not adopt the new coding system effective January 1 2017 Instead they continued to accept only a series of G codes for mammography services In addition there was no change for 2017 in the use of the add on code to charge for Digital Breast Tomosynthesis DBT CPT 77063 in conjunction with screening mammography and G0279 in conjunction with diagnostic mammography As providers we are on the edge of our seats waiting for CMS announcements trying to be proactive in updating our systems and workflows and disseminating the information to critical staff While CMS offers a specified code set many commercial insurers opt to delay implentation of new codes resulting in unforeseen claim denials and negatively impacted revenues Resolving claims denials and requesting claims review is extremely daunting even for the most experienced billing personnel Commercial payers tend not to be nearly as transparent as Medicare about their own requirements leaving medical billing professionals frustrated when there are new procedure codes or changes to existing coding in the American Medical Association s CPT code set or by federal regulation As if that s not confusing enough aligning EMR EHR systems to accommodate the required billing code sets for various carriers is potentially problematic and arduous Consider the following potential differences in 2017 For a Medicare patient who receives a screening mammogram without tomosynthesis the charge would be reported as G0202 If the screening mammogram includes screening tomosynthesis the claim would include both G0202 and 77063 In the event of a diagnostic mammogram the charges would be either G0204 bilateral or G0206 unilateral And if tomosynthesis is also included Medicare would be billed G0279 in addition to either G0204 or G0206 as appropriate 



However for commercial payers following CPT guidelines charges could look significantly different For a patient receiving a screening mammogram bill CPT code 77067 Screening mammogram and screening tomosynthesis bill codes 77067 and 77063 For Diagnostic mammograms report either 77065 unilateral or 77066 bilateral and if diagnostic tomosynthesis is provided also add G0279 Moving forward for 2018 CMS recently announced that new CPT codes will be implemented for Medicare beginning January 1 2018 It is expected but not required that commercial insurers follow along Because system updates are not always available on the first day of the rules changes its imperative that practices monitor the situation It is essential that radiology practices and their billers review denials promptly and follow up on any mismatched codes The age-old adage you have to spend money to make money applies to radiology practices on many levels First its well worth the investment to recruit expert medical billers and or coders It s advisable to seek professionals who have obtained accreditation in these fields Secondly review physician workflows and sort out processes that could be carried out by a well trained secretary or medical assistant 



This staff member could be assigned tasks which directly assist the physician while allowing the physician efficiently maximize conduct patient interaction and film reading Finally invest in training all members of your team This can be accomplished during regularly scheduled staff meetings to include specific content relevant to billing and compliance Much of billing parallels compliance and it will coincidentally satisfy yearly training requirements When everyone understands the process workflow expectation and ensuing consequence the results will increase both productivity and quality as well as bring costs into alignment with the actual services provided This, in turn, allows the physician to focus on enhancing every patient experience and providing quality care at appropriate costs Ultimately that is the goal of every physician



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