Despite the noise, CMS changes in 2018 will be minimal for Nuclear Medicine

CMS recently released the Physician Fee Schedule final rule for 2018, and after an eventful year, many nuclear cardiologists are wondering what 2018 will bring. While 2017 witnessed extensive changes to CMS rules, MIPS reporting requirements, and the highly-debated QPP final rule, it appears that dramatic changes are not on the horizon for 2018.

A Focus on Quality Improvement

In spite of all the debates, discussions, and general noise, there are no significant changes that will affect nuclear cardiologists in the 2018 rule. Current projections are seeing a 4.5% increase in PET procedures and a minimal increase, nearly static, in nuclear cardiology. Bundled hospital outpatient services and supports also remain the same.

The changes that are slated relate more to the quality initiative. As we’re moving into MIPS, the new reporting requirements will continue to evolve, but now with an expanded list of exclusions. Other revised rules make up the smallest list we’ve seen in years. The 700-page report is a stark departure from the typical 2,000 pages of prior years.

Changes in Private Payers Reimbursment

Generally, the industry seems to be in an acceptance phase, especially on the private payer side. They’ve resigned to the fact that the Affordable Care Act, in one form or another, is here to stay. Providers have seen a dramatic increase in accountable care plans and premiums are on the rise. Coverage is becoming more contracted, and there are more limitations on which services and procedures are covered.

A primary area of concern for Nuclear Medicine centers around private payers tightening restrictions on procedures, who can perform them, and the need for prior approvals. In total, revisions to CMS rules in 2018 appear to be minimal and will hopefully bring additional stability to reimbursement patterns.


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