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Radiology Payer Steerage to Free-Standing Imaging Centers

V

vrichmond

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Glenmora, LA
In 2017, Anthem announced it would begin steering patients to free-standing imaging centers as a cost-saving measure. Rather than pay higher rates to facilities, Anthem required authorization to cover high-res imaging in the Hospital Outpatient setting. Special circumstances, patients under the age of ten, or those in areas without reasonable access to a nearby imaging center would be approved for HOPD imaging. ER and Inpatient imaging were not involved. Recently, UHC announced it would begin reviewing site of service necessity before authorizing MRI and CT services in HOPD. I am looking for input from someone in a state where Anthem already rolled out its steerage policy. We know the arguments for both sides and I have read extensively on the presumed impact, but there is nothing I have found on what has actually been experienced. For Billers/Managers in hospitals, have you truly felt a dip in your imaging services?

Thank you!

V. Richmond, MHA, CPPM
 
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