Access Feedback: Getting paid for MRAs poses access challenge
Lack of documentation’ is issue
What are access managers doing to get Medicare reimbursement for magnetic resonance angiography (MRA)? That’s the question that Gillian Cappiello, CHAM, director of access services at Chicago’s Swedish Covenant Hospital, would like for her colleagues across the country to answer.
Her facility has a number of physicians who frequently order MRAs — most commonly of the neck and head — and "a bunch of neurologists" who order magnetic resonance imaging (MRI) and MRA at the same time, for both inpatients and outpatients, Cappiello says.
It seems that the only way the MRA passes Medicare scrutiny is if surgery is anticipated, Cappiello says. "Maybe we shouldn’t let any physician who isn’t a surgeon order the tests, but we also have the exams ordered by surgeons that get denied."
The reason given for the denial is always that there is not enough supporting documentation, she notes. "Most of the time [with denials], it’s the diagnosis that doesn’t pass, but in this case, it’s the lack of documentation."
"We came up with a process where physicians need to provide documentation before they schedule the MRA," Cappiello says. "We created a fax sheet to send them to check off the things they’ve included."
One of the items on the checklist is their office visit chart notes, she adds. "The documentation will then be reviewed by the radiologist to determine if in their opinion the test will meet medical necessity requirements."
The documentation will then be reviewed by the radiologist to determine if, in his or her opinion, the test will meet medical-necessity requirements, Cappiello says.
If the OK is given, she adds, the appointment center will call the patient to schedule the test. If not, the radiologist would call the ordering physician to either get more information — which would need to be provided in written documentation — or to decide whether to go ahead with the MRA and inform the patient he or she will need to sign an advance beneficiary notice, she notes.
Medicare’s position appears to be that there is no reason for an MRA until the physician already has reviewed an MRI and a carotid Doppler study and now is anticipating there will be surgery, Cappiello says. "It seems to be for that reason, anyway, but the language in the Local Medicare Review Policy takes some reading through."
[If you have feedback on this or other access issues, please contact editor Lila Moore at (520) 299-8730 or [email protected]. Gillian Cappiello can be reached at (773) 878-8200, ext. 5051 or [email protected].]
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