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A big deal’: CMS pilot puts onus on ordering providers to support necessity of radiology services

Radiology Billing, medical billing

CMS pilot puts onus on ordering providers to support necessity of radiology services


Imaging industry advocates are praising a new pilot process from CMS that puts the onus on ordering providers to help defend the medical necessity of radiology services.

The Centers for Medicare and Medicaid Services first announced the change last week, which is set to take effect on Dec. 1. It stipulates that Medicare Administrative Contractors should begin requesting any important documents from ordering providers during the review phase to determines whether payment is warranted.

“There are instances in which radiology service providers selected for review are unable to acquire supporting documentation, possibly retained by the treating/ordering practitioner,” the agency said in an Oct. 30 notification to MACs. “CMS is piloting an approach that will enable MACs to receive pertinent documentation from the treating/ordering practitioner during medical review, in an effort to support the necessity and payment for radiology services/items billed to Medicare.”

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