>>Health Insurance Companies Not Paying for Hospital-Based Outpatient Imaging – What Is Your Plan B?

Health Insurance Companies Not Paying for Hospital-Based Outpatient Imaging – What Is Your Plan B?

2019-02-24T19:58:22-06:00

While one can argue the efficacy of a recent movement by Anthem regarding their new imaging policy, but it is likely a predictor of more to come.  Anthem recently announced that it would no longer pay for outpatient MRI and CT scans performed in hospitals where options exist. What will be your plan B?  The Advis Group believes that a viable strategic option lies in the creation or partnering in Independent Diagnostic Treatment Facilities (IDTF).

What is an IDTF?

  • Diagnostic testing facility which is independent of both a physician’s office and a hospital
  • May be a fixed location or mobile
  • Requires enrollment under Medicare Part B
  • Requires a supervising technician

Why should I consider an IDTF?

  • Responsive to non-governmental payers’ potential non-coverage of hospital-based diagnostics
  • Expands the continuum of care
  • Responds to market competition
  • Increase market share and the ability to integrate easily into a System’s ambulatory care strategy
  • Governance, ownership and operational flexibility independent of the hospital’s structure

How do I get started?

There are several things to consider when setting up an IDTF.  For example – IDTF’s may not share space with another Medicare-enrolled individual or organization or lease or sub-lease operations or location with another Medicare-enrolled individual or organization.  Additionally, there are several structures that can be considered (sole ownership, joint venture, under arrangements, etc.).   The Advis Group is experienced in both start up IDTF’s as well as Turn Key IDTF’s (conversions).  The steps we take in determining the right options for our clients are comprehensive and include:

  • Feasibility/Market Assessment
  • Financial Impact
  • Structure
  • Regulatory Compliance
  • Licensure
  • Coding/Billing
  • This field is for validation purposes and should be left unchanged.