Digital Breast Tomo Coverage
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.
 
The CRS continues to do outreach to major plans to encourage that they reconsider any policies that deny coverage for DBT.  We recently met with Blue Shield policy managers and will be meeting with Anthem Blue Cross this month. Our thanks to Dr. James Schlund and his colleagues at the Chico Breast Center for hosting the Blue Shield meeting and representatives of Hologic who have provided key information on studies and changes being made to cover DBT by other plans around the country.

Out of Network Billing Legislation Moving in Final Month of Session
AB 533 (Bonta), which would have banned balance billing and created a process for determining  interim payment rates for out of network physicians who provide services in contracted hospitals and other facilities, remains under active consideration in the last month of the Legislative session. A small workgroup of Assembly Democratic and Republican members have been trying to develop a solution and the vehicle is now AB 72 with Assemblyman Bonta as the author with a number of co-authors from both sides of the aisle.
 
AB 72 passed the Senate Health Committee at the end of June with some additional amendments still under discussion. The interim payment amount for an out of network physician is now the greater of 125% of Medicare or the average contracted rate of the plan. The bill continues to contain an IDRP process whereby a physician/group could appeal for a higher level of payment above the interim payment amount. There is ongoing discussion on possible amendments to address the network adequacy requirements for plans that we believe contribute in large part to the out of network billing issue. The Legislature will adjourn for the year on August 31st. 
 
Medicare/ Noridian Announces Targeted Reviews for Certain Imaging Procedures
Computed Tomography, 70450 - Widespread Service Specific Targeted Review Notification
Noridian is initiating a service specific targeted review for CPT code 70450, computed tomography, head or brain; without contract material. Read the complete update.
 
Lumbar Epidural Injections, 62311 - Widespread Service Specific Targeted Review Notification
Noridian is initiating a service specific targeted review for CPT code 62311, injection(s), of diagnostic or therapeutic substances. Read the complete update.

CRS Needs Your Help
Dear Colleague, 

We appreciate your membership support for the CRS and recognition of the value CRS provides to all diagnostic radiologists and radiation oncologists. Although ACR provides exceptional advocacy at the federal level, CRS plays a crucial and albeit indispensable role at the state level on regulatory and legislative issues that have real impact on our specialties. For example, just in this current year:
  • CRS joined in a coalition to have DHCS/ Medi-Cal reverse a decision that would have effectively denied life-saving screening mammography to women between the ages of 40 and 50. The policy was announced and retracted within a matter of 10 days.
  • CRS successfully opposed legislation that would have limited out of network radiologists and radiation oncologists from balance billing providing an interim payment at Medicare rates. CRS remains engaged in finding an equitable solution that protects the patient.
  • CRS has sponsored a bill to require health plans and insurers to reimburse for digital breast tomosynthesis.
The CRS remains committed to advocate on behalf of you and the rest of our colleagues on these and other important issues.   However, over the past several years, the CRS has experienced a depletion of its reserves primarily due to declines in membership and unforeseen substantial losses from the traditional CRS Annual Meeting that now threaten the viability of the CRS and its ability to continue these important advocacy efforts on your behalf.  CRS leadership has a strategic plan in place to alleviate these financial woes including efforts to reduce expenses, increase membership, and explore new sources of revenue.  For example, as a part of this plan and as a means of reducing expenses, CRS will not hold its Annual Meeting this year in the fall as in years past but will instead pilot a joint program session at the LARS (Los Angeles Radiological Society) Midwinter Meeting in early 2017.
 
The CRS strategic plan will take time to implement but its advocacy efforts cannot wait. The CRS has an immediate and urgent need to replenish its reserves so that it can continue to advocate effectively on your behalf.  As such, CRS leadership has decided to take the unusual step of asking individual members and/or groups to make a ONE-TIME voluntary contribution to ensure the financial survival of the CRS. These funds will stabilize CRS finances in the short term so that it can continue its indispensable advocacy work while permitting the strategic plan to work and rebuild CRS reserves.

Please consider a voluntary contribution and may we suggest the following contribution levels for individuals or groups. Of course, any amount would be appreciated:

Individuals
Group/Corporate
$100-499 Supporter
$1000-2499 Bronze Sponsor
$500-999 Bronze Circle
$2500-4999 Silver Sponsor
$1000-4999 Silver Circle
$5000-9999 Gold Sponsor
$5000+ Gold Circle
$10,000+ Platinum Sponsor

Any contribution is deductible as a business expense. You can make a donation via credit card by clicking on this link to a PayPal account. The link is also on the CRS website at www.calrad.org. Checks can be sent payable to the CRS at 1 Capitol Mall, Ste. 800, Sacramento, CA 95814.

We will provide special recognition to all contributors and appreciate your consideration.  If you have any questions please do not hesitate to contact any of the CRS officers or the CRS Executive Director, Bob Achermann.

Thank you for your support of the CRS.

Sincerely,
 
Jinha Park, MD  . PhD     
President                                                              
 
Stephen Holtzman, MD
President-Elect 
 
Harvey Wolkov, MD, FACR, FACRO
Secretary
 
Mark Yeh, MD              
Treasurer                       
 
Janak Raval, MD, FACR
Past President