RCM tip of the day: Prepare for new rules on ordering tests for Medicare patients

Hospitals should begin preparing for new rules requiring referring providers to consult a clinical decision support system before ordering advanced diagnostic imaging services for Medicare patients, said Rebecca Farrington, chief revenue officer for Healthcare Administrative Partners, a provider of revenue cycle management solutions.

The guidance, effective Jan. 1, 2020, applies to advanced diagnostic imaging services such as computed tomography, diagnostic magnetic resonance imaging and nuclear medicine imaging procedures.

Ms. Farrington said failure to use a clinical decision support system before ordering these services for Medicare patients will result in a penalty, to be imposed beginning in 2021 or later. This means reimbursement loss to the hospital and radiologist for the procedure. 

"This rule obviously will impact the ordering physician and the rendering physician, as well as the hospital," she said. "Begin now to form a team that includes the appropriate hospital parties along with stakeholders from the medical community who will work together to assure a successful implementation."

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.


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