sample of payment differences between
governmental and private insurers. If a
physician practice, freestanding facility,
or radiology department has signed a
participation agreement or managed care
contract with an individual payor, the
healthcare entity has agreed to abide by
that payor’s coverage policies, bundling
Available at: http://www.cms.gov/
Melody W. Mulaik is president and co-founder of
Coding Strategies, Inc. She is a nationally recognized
speaker and has delivered numerous presentations at
AHRA annual meetings and conferences. Melody is a
member of AHRA, has published extensively, and may
be contacted at firstname.lastname@example.org.
The world in which we function gets
more and more complicated every year.
One thing that is not going away is the
role of medical necessity in the determination of payment for radiology services.
Help yourself and your organization and
find out how your top payors address this
“Medicare Program Integrity Manual.”
Local;Coverage;Determina-tions. Available at: http://www.cms.hhs.
2American Medical Association. “Prepare that
Claim: Taking an active approach to the
Available at: http://www.ama-assn.org/