CMS: Final Steps Toward Medicare Imaging Demo
A new demonstration project slated to begin in July will assess whether decision support systems and a new payment method decrease the amount of advanced imaging services physicians order for their Medicare patients. The Centers for Medicare & Medicaid Services (CMS) recently released claims processing instructions to contractors and announced the selected participants for overseeing the Medicare Imaging Demonstration (MID).
The demonstration, a provision of the Patient Protection and Affordable Care Act (PPACA) (section 3113), is intended to establish a separate payment method for complex diagnostic tests with a date of service that would, under standard Medicare rules, be bundled into payment for an associated hospital inpatient stay. CMS will conduct the demonstration project for a period of two years, beginning July 1 or until the $100,000,000 payment ceiling is reached.
The demonstration includes only advanced diagnostic imaging services provided to Medicare fee-for-service patients paid under Part B, including services provided by an outpatient clinic. Inpatient (Part A) and emergency department (ED) imaging services are excluded, as are services provided as part of the outpatient encounter and paid under the Outpatient Prospective Payment System (OPPS). Approaches requiring prior authorization also are excluded.
Under the demonstration, CMS will allow independent and hospital-based labs to bill separately for certain complex diagnostic services ordered within a 14-day period after a hospital discharge.
Advanced imaging modalities include: magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine. Specifically, the demonstration will assess 11 of the most costly and widely used tests: Spect myocardial perfusion imaging (MPI), MRI lumbar spine, CT lumbar spine, MRI brain, CT brain, CT sinus, CT thorax, CT abdomen, CT pelvis, MRI knee, and MRI shoulder.
The five MID participants CMS has selected are: Brigham & Women’s Hospital, Henry Ford Health System, Maine Medical Center-Physician Hospital Organization, University of Wisconsin-Madison, and National Imaging Associates. These so-called “conveners” will, among other things, recruit physicians to participate in the demonstration. CMS hopes to get approximately 2,500 to 3,500 physicians from 500 to 650 practices varying in size, specialty, type, and location.
Conveners also are responsible for distributing physician incentive payments to participating practices. The maximum possible incentive payment to participating physicians is approximately $40,000 per practice over the course of the two-year demonstration period and conditional on the historic ordering volume of the 11 procedures included in the demonstration.
Additional information about this demonstration project can be found on the CMS website.