Billing I-AIM: a novel framework for ultrasound billing

Abstract

Background: Point-of-care ultrasound (POCUS) has an ever-growing footprint in medicine. With this growth POCUS billing and reimbursement has become an area gaining quite a bit of attention as a means of funding and sustaining quality and education programs. Standardization across providers is needed to improve the financial viability of POCUS. Results: We created an institutional collaborative which developed a framework to identify critical POCUS billing and reimbursement checkpoints. The framework, Billing I-AIM, provides a feasible structure to enhance provider-based reimbursement and perform quality improvement efforts across variable POCUS environments. Conclusions: POCUS billing using the Billing I-AIM technique allows administrative oversight, quality assurance, and educational functions as well. A discussion of the framework and respective application is provided.

Guide to Intestinal Ultrasound Credentialing, Documentation, and Billing for Gastroenterologists in the United States

“…Similar to point-of-care ultrasound in other specialties such as emergency medicine, we have created a guide to serve as a simple framework to facilitate gastroenterologists' adoption of IUS at the point of care to encourage appropriate training and credentialing and to receive appropriate reimbursement for services rendered (7). We have provided a 5-step simple planning framework to guide the process and ensure all requirements for billing and reimbursement are met (Figure 2).…”

Impact of Emergency Medicine Point-of-Care Ultrasound on Radiology Ultrasound Volumes in a Single Pediatric Emergency Department

“…However, research based on claims and payment data may significantly underestimate the volumes of POCUS examinations performed. Many POCUS examinations are not billed because of lack of documentation and coding infrastructure, and high rates of claim denials have been reported, with only 0.7% of EM providers receiving payments for POCUS from CMS in 2012 [26,27]. Although cost savings associated with EM POCUS at a single institution have been described [28], higher volumes of follow-up imaging have been documented in nationwide Medicare data when US is interpreted by a nonradiologist [10].…”

Nuts and Bolts of a POCUN Program

“…Applying appropriate ICD-10 and CPT codes for the POCUN studies you most often perform will benefit from working with your billing and coding experts to ensure the documentation will support billing. An in-depth review of documentation and billing is beyond the scope of "Nuts and Bolts" and recently published frameworks such as "Billing I-AIM" by Hughes, et al, provide an excellent and detailed discussion of POCUS billing that is generalizable to nephrology or other subspecialty practices [34]. While investigation specific to nephrology is lacking, implementation of billing for POCUS activities in a singlecenter experience at a tertiary care emergency department produced a net profit within one year.…”