Higher-quality MRIs Raise Questions about Costs and Reimbursement

Scott Wallask, for HealthLeaders Media , July 14, 2009

Private payers, however, are using radiology benefits managers to negotiate reimbursement rates with hospitals and other providers. In those situations, a radiology benefits manager may set lower rates for 1.5 Tesla MRI exams, but also point more referrals to sites with those machines as opposed to facilities with 3 Tesla magnets, Gilk says.

Private payers are also asking hospitals whether a 3 Tesla exam was truly needed for a diagnosis, and if the answer is hazy, the payer could reject the claim, Robertson says.

In fact, it's not yet clear whether the higher-quality images from 3 Tesla MRIs have a positive effect on diagnostic outcomes, Gilk says.

It is important when considering ultrahigh-field-strength MRIs—or any of the other technologies discussed in the ECRI Institute's white paper—for CEOs to get all affected parties to the table, not just biomedical engineering and physicians, Robertson says. For example, with reimbursement rates potentially in question for higher-strength MRIs, it makes sense for a hospital's clinical coding team to be involved in MRI purchasing decisions, she added.

Scott Wallask is senior managing editor for the Hospital Safety Center. He can be reached at swallask@hcpro.com.

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