- The Centers for Medicare and Medicaid Services will now allow interventional cardiologists to identify themselves as such for reimbursement purposes.
- According to Society for Cardiovascular Angiography secretary Peter Duffy, MD, MMM, interventional cardiologists will no longer face denied claims for referrals from general cardiologists within the same group. "Our electrophysiology colleagues are already in that situation," said Duffy. "We're doing the work, we're just not getting paid for it."
- To have their designation changed from general cardiology to the new C3 category, providers need to make a request to their local Medicare provider.
This should open up reimbursement opportunities for interventionalists in the private sector as well—what Medicare does, the private payers usually follow suit—which should come as good news to many providers.
According to Duffy, the recognition will also have an impact on how cardiologists are considered under the evolving ACO model.
"Right now general cardiology would be considered to be an included physician in an ACO model," Duffy told MedPage Today. "If you admitted the patient to the hospital that patient would be attached to you. Even if they went to other hospitals and were out of your system, your ACO would still be responsible for any services that they received there. As interventionalists, we're more designated to be doing specific procedures for patients ... As excluded physicians from an ACO model, we would not be the designated primary care provider, which we shouldn't be under that circumstance."