ALL ABOARD!

Portable x-ray Providers for Railroad, Traditional and Medicare Advantage plans will be asked to show tickets in the near future.

As portable x-ray providers and Long Term Care (LTC) facilities boarded the “Party Train” with the release of the 2013 Medicare Physician Fee Schedule, which clarified that non-physician practitioners and others are now permitted to an order a portable x-ray, we almost overlooked the “gap” between the train and the platform.  With all the cost saving measures taking shape under the Affordable Care Act, we could have guessed this was coming. 

In May of this year, Palmetto GBA, as the Railroad Retirement Board’s Specialty Medicare Administrative Contractor, announced a “widespread review of radiology services.”  While Palmetto’s use of “widespread” may only be a harbinger of things to come, the first phase of this review is focused on claims submitted under CPT codes 71010 and 71020.  The Medical Review unit will call to question a sample group of claims from portable x-ray providers by sending out ADRs, or Additional Documentation Requests about the specific claim.  When a provider receives an ADR, they will be asked to reply within 45 days with the following information:

Support for billing the Technical Component (TC):

1.      Documentation to support the service was rendered. (Example: The diagnostic test report.)

2.      A signed order, or documentation that clearly reflects the ordering provider’s intent.

Further, if the provider is billing for the Professional Component (PC):

1.      A signed diagnostic test report.

2.      A signed order, or documentation that clearly reflects the ordering provider’s intent.

At Source Diagnostics, we work closely with our partners to ensure proper documentation of these requirements, whether a patient is covered by Palmetto’s Railroad Medicare or not and regardless of the CPT code.   We believe this “widespread” review will mature into an extensive cost saving investigation for all carriers, CPT codes and providers in the near future. 

If you are a client, you’re already aware that ALL orders we take contain 5 elements, which in conjunction with 42 CFR 486.106, provide the information needed for the signed order requirement of Palmetto’s ADRs.  

• The reason a portable x-ray is required;
• The area of the body to be exposed;
• The number of radiographs to be obtained;
• The views needed; and
• A statement concerning the condition of the patient which indicates why portable x-ray services are necessary.

As the healthcare environment becomes more adept at managing the massive amount of data required for these cost saving measures, Source Diagnostics remains ahead of the curve for our clients; to provide the most outstanding protection against the fear of slipping into the gap and missing out on the party train.  Anybody wanna take this ride?