Imaging centers help doctors diagnose and treat patients. They provide services like MRI, CT scans, mammograms, and X-rays. But not all imaging centers are owned or run the same way. Some are owned by hospitals, and others are independent. This difference changes how much patients pay, how insurance covers costs, how billing works, and what the patient experience is like. This article looks at the differences between hospital-owned and independent imaging centers in the United States. It also explains how these differences affect healthcare providers, managers, and IT staff who work with these centers.
Before 2015, many hospitals owned imaging centers that were off the main hospital campus. Hospitals liked this because they got more money from Medicare to cover extra costs. These off-campus hospital outpatient centers were paid more than doctor’s offices or independent centers. This gave hospitals a financial benefit when they owned imaging centers away from the main hospital.
The Bipartisan Budget Act of 2015 made big changes to how Medicare pays for imaging services at off-campus hospital centers.
Starting January 1, 2017, Medicare lowered payments for the technical part of imaging services at these hospital centers. They moved from a higher payment system (OPPS) to a lower one (MPFS). At first, Medicare paid 50% of the old amount, then reduced it to 40% by 2018. This made hospitals earn less from owning these centers. It’s important to know that only payments for the equipment and facility went down. Radiologists’ fees for reading images stayed the same.
Before these changes, hospitals billed Medicare using the OPPS system, which includes extra costs for running the hospital. Now, hospitals get paid less, like doctor offices and independent centers.
Hospital-owned imaging centers have billing that can be confusing.
The hospital bills for the technical part. This means use of machines, staff, and building costs. This is done under OPPS rules. The radiologists bill separately for reading the images under the MPFS system.
This two-bill system can confuse patients. They may get two bills for one test. If the hospital and the radiology group take different insurance plans, patients might have to pay more out of pocket. This surprise can make patients unhappy and harm trust in healthcare. It also makes it harder for hospitals and radiologists to collect payments.
Sandy Coffta, a health services official, says imaging centers should tell patients about billing when making appointments. This can help patients avoid surprise bills. Coffta also says that if possible, combining both bills into one can make things easier for patients and reduce paperwork.
Many studies show hospital-owned imaging centers charge more than independent centers.
Insurance companies like Anthem limit coverage for MRI and CT scans at hospital centers. They say these centers charge 70% to 149% more than independent centers. This policy affects about 4.5 million people in 13 states. Anthem tells patients to use independent centers unless they live in rural areas where options are limited.
Patients can save a lot by choosing independent centers. Savings can be up to $1,000 if they have not met their deductible or $200 for copay plans.
Hospital-owned centers usually have higher facility fees. This makes patient deductibles and copays higher. Independent centers often have lower fees, so patients pay less overall.
But patients often find it hard to understand these billing differences. Separate bills from hospital and radiology groups and mixed insurance acceptance add to the confusion. This can delay payments and upset patients.
Leah Binder, CEO of the Leapfrog Group, warns that making patients use independent centers just for cost reasons could cause care to be split up or hurt quality. Not all centers give the same quality or accuracy. Switching between hospital and independent centers can complicate care, especially for sensitive patients like those with cancer. Cancer patients might have to handle separate imaging centers, move images, and make sure results are recorded properly.
Dr. Vijay Rao from Thomas Jefferson University notes that errors can happen when patients manage their own imaging files because hospital and independent systems often do not work well together.
Global billing means hospitals and radiologists bill together in one bill. This can make billing easier and less confusing for patients. It also lowers administrative work and helps with insurance coverage consistency.
When hospitals and radiologists accept the same insurance plans, patients have fewer denied payments or surprise bills. This helps hospitals manage money better and keeps patient trust.
For administrators, having both the hospital and radiologists accept the same insurance makes prior authorizations, copay collection, and billing simpler and lowers risks of claim denials.
Medicare payment changes push hospitals to rethink owning imaging centers.
By lowering payments for technical services at off-campus hospital centers, Medicare tries to control imaging costs.
The payments were cut to 50% in 2017 and then to 40% in 2018 compared to the old hospital rates. This discourages hospitals from buying more off-campus imaging centers just for better payouts.
These changes make payment levels fairer among hospital-owned, doctor-owned, and independent centers. Hospitals are now motivated to lower costs and improve patient experiences.
National policies by insurers and Medicare aim to reduce costs. But access to imaging in rural areas remains a worry.
Anthem and other insurers usually exempt rural areas if there are not enough independent imaging centers. This helps keep access for people in medically underserved or remote areas.
However, rural hospital-owned centers still charge more than urban or critical access hospitals. High prices with fewer choices can make it hard for rural patients to afford care. This may increase differences in healthcare quality.
New technologies like artificial intelligence (AI) and workflow automation are useful for the people who manage imaging centers. These tools can help with billing, scheduling, and talking to patients, especially with the complex ownership and billing rules.
Changes in payment rules and regulations affect how imaging centers work. They impact billing, patient satisfaction, and how smooth operations are. Managers and IT staff need to understand how ownership and payment rules affect:
Using AI-powered tools can make work easier, reduce errors, improve payment collections, and help patients understand costs better.
The imaging services market in the U.S. is shaped by rules, ownership, insurance, and technology. Hospital-owned imaging centers usually cost more and have complex billing. This affects patients’ finances and makes work harder for providers. Independent centers often have lower costs and are preferred by insurers trying to reduce patient expenses.
Practice administrators and owners need to adjust workflows and patient communications to these changes. Using technologies like AI can help keep operations efficient and improve patient satisfaction in this changing system.
The Bipartisan Budget Act of 2015 changed reimbursement for off-campus HOPDs from the higher Outpatient Prospective Payment System (OPPS) fee schedule to the Medicare Physician Fee Schedule (MPFS), starting January 1, 2017, reducing payments to 50% and later to 40% of the OPPS.
Hospital ownership was attractive due to OPPS providing higher reimbursement rates compared to independent imaging centers. However, recent legislative changes have prompted hospitals to reconsider this model.
Radiologists face challenges with revenue cycle management, as billing is separated between the facility (technical component) and the radiologists (professional component). This can complicate collections and patient registration processes.
If a radiology group is out of network for a plan that a hospital participates in, patients could face significant bills without coverage, leading to poor patient experiences and collection issues.
Patients may receive different levels of insurance coverage depending on whether the imaging center is hospital-owned or independent, often resulting in higher deductibles and out-of-pocket costs at the hospital.
Global billing simplifies the patient’s financial experience by consolidating charges into one bill, increasing marketability and potentially improving cash flow and patient satisfaction.
Insurers are increasingly favoring freestanding, non-hospital facilities because they can provide services at lower costs compared to hospital-based settings.
They should clarify the billing structure and inform patients that they might receive separate bills for the radiology professional services and the facility, allowing them to check their insurance coverage.
The reimbursement changes may reduce financial advantages of hospital ownership, prompting imaging centers to consider alternate strategies that emphasize lower costs and improved patient experiences.
Prioritizing patient satisfaction is crucial for revenue maximization in radiology practices, as a positive experience can lead to quicker payments and better patient retention.
Simbo is using AI agents to automate all phone related workflows. Connect now to know more.
Schedule AI Agents Demo Now© Since 2019, Simbo AI.
