​In 2006, the AMA’s CPT® Editorial Panel established six Category III CPT® codes to describe cardiac computed tomography angiography with contrast materials (cardiac CT services) effective January 1, 2006. In 2010, the six codes were replaced with three Category I CPT® codes, 75572, 75573, and 75574.  The three codes have been paid in alignment with the HOPPS payment rate methodology based on geometric mean cost, ranging from $175-$265 from CY 2015 through CY 2024.

​Magnetic Resonance (MR) safety is a critical concern due to the powerful magnetic fields and radiofrequency energy used in Magnetic Resonance Imaging (MRI) scans. The MR environment has the potential to pose significant risks to patients with implanted medical devices or foreign bodies. These objects may heat up, move, or malfunction, potentially causing harm. Prior to 2025, there was no specific way to report the extra effort involved in assessing and mitigating these risks before an MR exam or procedure. Now, providers can be reimbursed for the essential tasks required to safeguard these patients, including implant or foreign body evaluation, implant positioning or immobilization, safety consultation, and preparation of electronic devices. This change acknowledges the importance of MR safety protocols and supports the necessary steps to protect patients while maintaining imaging quality. 

​Stay on top of coding and reimbursement guideline updates for the new year with our comprehensive summaries of the CY 2025 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) Final Rules. Packed with insights into key updates and changes impacting healthcare providers, these resources are essential for understanding how reimbursement, policy shifts, and coding updates will shape the year ahead. Don’t miss this opportunity to prepare your organization—download the full summary today by filling out the form below.

​As healthcare continues to evolve, so too do the models that determine how providers are reimbursed for their services. With an increasing shift from procedure-based payments to those that rely heavily on diagnosis coding, ensuring your practice is prepared for these changes is essential for long-term success. The ICD-10-CM diagnosis code set, once considered secondary to procedure codes in reimbursement, is now playing a more central role, making precise documentation critical.

By: Ron DiGiaimo, MBA, FACHE, and Briauna Driggers

​The Physician Fee Schedule (PFS) determines how physicians are paid for their services and is essential in the healthcare reimbursement process. However, in the field of Radiation Oncology (RO), the current state of PFS has been facing consecutive years of significant challenges. 

Teleradiology facilitates the remote diagnosis and treatment of patients across the globe by providing a crucial component of telemedicine and revolutionizing the way diagnostic imaging services are delivered. This innovation enhances access to specialized imaging interpretation services and significantly improves the efficiency and reach of healthcare delivery. Teleradiology is beneficial to healthcare services in many ways. The utilization of teleradiology services can enable a facility to reduce its out-of-pocket costs, provide 24/7 radiological services, increase the number of physicians available for consultation, and expedite and improve patient care.

By: Briauna Driggers

In 2022, a new Hospital Price Transparency Rule came into effect. Unfortunately, many hospitals are struggling to implement these new standards and are facing difficulties into 2023.
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Regulations and best practices are always changing in the healthcare industry. Healthcare audits are designed to help facilities provide the most efficient and effective patient care, but they can also be a source of stress and frustration for organizations. Failing a healthcare audit can lead to financial and legal penalties. 

By: Briauna Driggers and Juan Arredondo

Medicine is an essential service. Yet, healthcare providers still need to make enough profit to cover their overhead costs if they want to keep their doors open. That is why it is essential for your business and community that claims are processed accurately and you get reimbursed for your services.
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Unfortunately, claim denials are on the rise, up over 20% since 2016. The COVID-19 pandemic only exacerbated the situation. There was a sharp rise in patients seeking medical care and an 11% increase in claim denials nationally. While almost 85% of these denials are preventable, about a quarter of them cannot be recovered. 

By: Ron DiGiaimo, MBA, FACHE, and Ben Adams

​The COVID-19 pandemic has put tremendous financial stress on the healthcare industry and analysts are forecasting that operating margins will be challenging for the remainder of 2021. Procedures such as elective surgeries are being placed on hold as available physical space within the hospital walls is limited. Additionally, longstanding staff shortages continue and likely will increase through 2030.