Friday, July 01, 2016 03:05 PM

3D Mammography - Breast Tomosynthesis payer denials: A strategy to secure reimbursement

You have a right to be paid for providing service!

Providers of 3D Mammography/Breast Tomosynthesis are flooding the Department of Managed Health Care (DMHC) with requests for Independent Medical Reviews (IMRs). DMHC has received over 400 IMR requests per week. Currently they have about 325 decisions.  90% of IMRs filed have been overturned and claims paid by the insurer.

Below is a link to CA AB bill No. 2764, which states in part, “Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of its provisions a crime. Existing law provides for the licensure and regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts, except specialized health care service plan contracts, and certain health insurance policies to provide coverage for mammography for screening and diagnostic purposes.

Tuesday, June 14, 2016 11:21 AM

VA Proposal Would Let Nurses Take on Imaging Duties

By Brian Casey, staff writer (Copyright © 2016

Advanced-level nurses would be able to order and interpret some medical imaging exams in the U.S. Department of Veterans Affairs (VA) health system under a proposal issued late last month. Advocates for radiology are vowing to fight the proposal, saying it would compromise patient care and lead to inappropriate imaging utilization. In a May 25 proposed rule in the Federal Register, medical imaging exams are among a number of specialty procedures that could be performed by nurses with advanced training. The proposal says it is designed to "increase veterans' access to healthcare by expanding the pool of qualified healthcare professionals" who are authorized to provide health services without the supervision of physicians. 

Read this full article at >

View details of the proposed rule at >

Comments on the proposed rule are due to the VA by July 25, 2016:

Written comments may be submitted through; by mail or hand-delivery to Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC 20420; by fax to (202) 273-9026. Comments should indicate that they are submitted in response to “RIN 2900-AP44-Advanced Practice Registered Nurses.” Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1068, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except holidays). Call (202) 461-4902 for an appointment. (This is not a toll-free number.) In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at

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