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Medicare Will Likely Cut Imaging Reimbursement in 2014

The recently enacted American Taxpayer Relief Act (Public Law 112-240), also known as the legislation that averted the fiscal cliff, made a seemingly minor change, effective 2014, to the formula Medicare uses to determine reimbursement for imaging services. Section 635 of the Act requires Medicare to use a 90% utilization rate when determining how much to pay providers for these services.  Medicare previously used a 75% utilization rate. The utilization rate is used to determine a portion of the practice expense component of Medicare RVUs. When the utilization rate increases, Medicare assumes that equipment is used more frequently. As a result, the cost per use decreases, since the cost of the equipment is spread across more uses. This results in lower reimbursement.

While the utilization rate change is effective starting in 2014, providers may wish to assess the future of in-office imaging during 2013.

For text of the American Taxpayer Relief Act, please use this link.

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About this Author

von Briesen & Roper’s Health Care Practice Group provides comprehensive legal services to the health care industry nationwide as both general counsel and special project counsel. Our clients include multi-hospital integrated systems, academic medical centers, community hospitals, Catholic-sponsored hospitals, rural and critical access hospitals, imaging centers, physicians and multi-specialty clinics, and specialty hospitals.