Medical Imaging Modernization Act of 2015

To amend title XVIII of the Social Security Act to provide Medicare payment incentives to transition from traditional x-ray imaging to digital radiography, and for other purposes. 1. Short title This Act may be cited as the Medical Imaging Modernization Act of 2015 2. Medicare payment incentive for the transition from traditional x-ray imaging to digital radiography and other Medicare imaging payment provision (a) Physician fee schedule (1) Payment incentive for transition (A) In general Section 1848(b) of the Social Security Act ( 42 U.S.C. 1395w–4(b) (9) Special rule to incentivize transition from traditional x-ray imaging to digital radiography (A) Limitation on payment for film x-ray imaging services In the case of imaging services that are X-rays taken using film and that are furnished during 2017 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global fee) of such services that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 20 percent. (B) Phased-in limitation on payment for computed radiography imaging services In the case of imaging services that are X-rays taken using computed radiography technology— (i) in the case of such services furnished during 2018, 2019, 2020, 2021, or 2022 the payment amount for the technical component (including the technical component portion of a global fee) of such services that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 7 percent; and (ii) in the case of such services furnished during 2023 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global fee) of such services that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 10 percent. (C) Computed radiography technology defined For purposes of this paragraph, the term computed radiography technology (D) Implementation In order to implement this paragraph, the Secretary shall adopt appropriate mechanisms which may include use of modifiers. . (B) Exemption from budget neutrality Section 1848(c)(2)(B)(v) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B)(v) (X) Reduced expenditures attributable to incentives to transition to digital radiography Effective for fee schedules established beginning with 2017, reduced expenditures attributable to subparagraph (A) of subsection (b)(9) and effective for fee schedules established beginning with 2018, reduced expenditures attributable to subparagraph (B) of such subsection. . (2) Elimination of application of multiple procedure payment reduction Section 1848(b)(4) of the Social Security Act ( 42 U.S.C. 1395w–4(b)(4) (E) Elimination of application of multiple procedure payment reduction (i) In general Not later than January 1, 2016, the Secretary shall not apply a multiple procedure payment reduction policy to the professional component of imaging services furnished in any subsequent year that is prior to a year in which the Secretary conducts and publishes, as part of the Medicare Physician Fee Schedule Proposed Rule for a year, the empirical analysis described in clause (ii). (ii) Empirical analysis described The empirical analysis described in this clause is an analysis of the Resource-Based Relative Value Scale (commonly known as the RBRVS (I) work sheets and other information detailing which physician work activities performed given the typical vignettes were assigned reduction percentages of 0, 25, 50, 75 and 100 percent; (II) a discussion of the clinical aspects that informed the assignment of the reduction percentages described in subclause (I); (III) an explanation of how the percentage reductions for pre-, intra and post-service work were determined and calculated; and (IV) a demonstration that the Centers for Medicare & Medicaid Services has consulted with practicing radiologists to gain knowledge of how radiologists interpret studies of multiple body parts on the same individual on the same day. . (b) Payment incentive for transition under hospital outpatient prospective payment system Section 1833(t)(16) of the Social Security Act ( 42 U.S.C. 1395(t)(16) (F) Payment incentive for the transition from traditional x-ray imaging to digital radiography Notwithstanding the previous provisions of this subsection: (i) Limitation on payment for film x-ray imaging services In the case of imaging services that are X-rays taken using film and that are furnished during 2017 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global fee) of such services that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 20 percent. (ii) Phased-in limitation on payment for computed radiography imaging services In the case of imaging services that are X-rays taken using computed radiography technology (as defined in section 1848(b)(9)(C))— (I) in the case of such services furnished during 2018, 2019, 2020, 2021, or 2022 the payment amount for the technical component (including the technical component portion of a global fee) of such services that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 7 percent; and (II) in the case of such services furnished during 2023 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global fee) of such services that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 10 percent. (iii) Application without regard to budget neutrality The reductions made under this paragraph— (I) shall not be considered an adjustment under paragraph (2)(E); and (II) shall not be implemented in a budget neutral manner. .

Summary: Medical Imaging Modernization Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to make a special rule reducing by 20% the payment under the physician fee schedule and the hospital outpatient prospective payment system for the technical component of imaging services that are x-rays taken using film. Imaging services that are x-rays taken using computed radiography technology shall have the technical component payment: (1) for services furnished from 2018 through 2022 reduced by 7%; and (2) for services furnished during 2023 or a subsequent year reduced by 10%. Reduced expenditures attributable to incentives to transition to digital radiography under the physician fee schedule are exempt from budget-neutrality calculation. The Department of Health and Human Services may not apply a multiple procedure payment reduction to the professional component of imaging services furnished before it publishes, as part of the Medicare Physician Fee Schedule Proposed Rule for a year, a empirical analysis of the Resource-Based Relative Value Scale (commonly known as the "RBRVS") Data Manager information used to determine what, if any, efficiencies exist within the professional component of imaging services when two or more studies are performed on the same patient on the same day. These payment reductions under the hospital outpatient prospective payment system for the transition from traditional x-ray imaging to digital radiography shall apply without regard to budget neutrality.