CRS News and Updates  

 

Insurance/ Plan Payment for Digital Breast Tomosynthesis

 
 

Sep. 1, 2016 - The CRS continues to push for coverage of DBT by private insurers.  Existing law requires insurers and plans to cover all screening and diagnostic mammography services ordered by a physician but almost all are denying coverage for DBT claiming it is investigational. Though our sponsored bill AB 2764 (Bonilla) stalled in the Assembly fiscal committee in recent weeks the following has occurred. 

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Out of Network/ Balance Billing Legislation Sent to Governor

 
 

Sep. 1, 2016 - AB 72 (Bonta) is the new vehicle which would ban balance billing and create a process for determining interim payment rates for out of network physicians who provide services in contracted hospitals and other facilities. A small workgroup of Assembly Democratic and Republican members have been developing a compromise solution involving all stakeholders including physicians.
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Digital Breast Tomo Coverage

 
 

Aug. 1, 2016 - Though CRS sponsored legislation, AB 2764 (Bonilla), was held in the Assembly Appropriations Committee we continue to work to get the major payers to cover DBT. Many groups have helped their patients file Independent Medical Review (IMR) requests with the Department of Managed Health Care if their plan denies payment for DBT claiming it is investigational/ experimental. The DMHC website shows some 351 IMRs reviewed for DBT with over 90 % of the decisions reversing the plan denial of coverage. Please continue to encourage or assist your patients file IMRs if you provide DBT.
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CRS Bulletin

 

CRS Bulletin magazine is published quarterly to CRS members about new developments or resolutions on legislative, regulatory, or practice management issues that affect diagnostic radiologists, radiation oncologists, or interventional radiologists.  Inquiries should be addressed to Bob Acher

mann at the CRS office by phone at (916) 446-2028 or e-mail at bachermann@amgroup.us.

 
   

CRS Updates

 

CRS' e-newsletter is a member benefit of the California Radiological Society (CRS). It is published as needed to alert members to the latest in legislative, regulatory, or practice management issues.  Inquiries should be addressed to Bob Achermann at the CRS office by phone at (916) 446-2028 or e-mail at bachermann@amgroup.us.

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