Radiology Medi-Cal Rates Will Be Reduced Retroactive to 10/01/10
We had previously informed you that part of the recently approved state budget included reductions in radiology reimbursement under Medi-Cal. The budget requires that radiology reimbursement not exceed 80% of the equivalent Medicare payment for the same service. Some of the more expensive modalities like MRI and PET will be greatly impacted since some of those Medi-Cal allowables were at or above the average Medicare payment for California. The changes would bring any allowable over 80% down to that level, but does not require any current allowable that is under 80% of Medicare to be raised.
CRS was informed that the new rates are being finalized and will be submitted to HP, the Medi-Cal fiscal intermediary. They will be tested and as a result providers may not see changes in payment immediately but the new rates are for dates of service on or after October 1st. We will review the new rates and provide more information.
The CRS opposed these reductions but eventually lost the fight in a budget environment with a massive deficit. The average physician payment under Medi-Cal is 52% and clearly radiology suffered from the reductions to Medicare via the DRA. We informed the Budget Conference Committee that these reductions will impact Medi-Cal patient access to radiology services and believe that the program will see the impact. We will continue to explore how we might roll these changes back.
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