Slim has been deeply involved in the reimbursement aspect as a SCCT representative on the CPT panel of the American Medical Association (AMA) and as part of the American College of Cardiology (ACC) Coding Task Force. He is also a member of the SCCT Board of Directors.
“A lot of us, when we went through medical school and residency, we didn’t get a lot of training or education about how we get paid and how we get reimbursed for a new technology,” Slim said. “During my session, I wanted to demystify the process and help people understand how a new technology is remunerated.”
As he was involved in the process, he explains from experience how AMA CPT codes are developed, including the professional description of the services provided, the technical component to perform the service and the gathering of clinical evidence to demonstrate why the procedure or technology should be reimbursed based on improvement in patient outcomes.
He also explains the process and high importance of the Relative Value Scale Update Committee (RUC) survey, which is used to recommend relative value units (RVUs) to the Centers Medicare and Medicaid Services (CMS). Slim said the RUC survey will be sent to providers to complete so they can explain the workload involved in completing the exam or service. This provides a basis for the value sand resulting payment for the exam by CMS. This is the professional component of reimbursements. However, CMS fees are often based on RUC surveys with a very low response rate as there is little interest in spending the time filling out these involved documents.
The technical component of fees includes the costs of the nurse, technologist, contrast agent, and other factors and supplies needed to perform the exam.
The technical and professional components can be combined into a global CPT bundled billing, or it can be separated. Slim said the professional component is often removed by hospitals when an exam is read by a third-party radiologist or cardiologist, who would bill the licensed professional separately.
Unfortunately, you learn all this on the job’, explains Slim. “That’s a shortcoming for all of us. The associations and even medical schools don’t offer classes to explain this.”
He said this has become a problem as fees decline and it is clear that more education is needed. “Regardless of all the advocacy efforts out there, if the grassroots members of the imaging societies don’t understand what parts they need to succeed, no matter how much you advocate, that success won’t be attainable because the majority of people don’t have the resources. to do well. This is an area where all medical schools and societies could do better.”
Slim said it’s not just a matter of getting paid for services rendered, it also impacts patient care if doctors don’t understand the system or how to bill it. “It’s not just self-fulfilling because if we don’t do it right, we just get paid. It’s also for the patient,” he explained. “If we don’t do it right, patients won’t get the procedures they need.”
Full information on new codes can be found on the AMA website.
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