A press release from the offices of U.S. Senators John Boozman (R-AR) and Ben Ray Luján (D-NM) announced that they will introduce The Medicare Access to Radiology Care Act (MARCA) in the next Congress to allow radiologists to submit claims to Medicare for “non-diagnostic services performed by radiologist assistants (RAs) they directly supervise in both the hospital and office setting.” 

In those states where radiologist assistants are legally authorized to perform services, the legislation would permit radiologist assistant services to be reimbursed to the RA's supervising physician at 85% of the Medicare Physician Fee Schedule payments amount for services “incident to” the supervising radiologist's services. But unlike other “incident to” services that are restricted to office settings, the new payment mechanism for RA services would be permitted in office, hospital and ASC settings. The RA payments relate to physician services and do not impact payment for the technical component of diagnostic tests. Further, such payments are made only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

The term ‘radiologist assistant’ means a radiographer who is certified by the American Registry of Radiologic Technologists as a registered radiologist assistant or by the Certification Board for Radiology Practitioner Assistants as a radiology practitioner assistant to perform radiologist assistant services.

It is hard to say how seriously the legislation will be considered. Unfortunately, the patrons have premised their support on faulty information. The press release issued last week stated that beginning in 2019, “the Centers for Medicare & Medicaid Services [CMS] adjusted RA supervision requirements, which allowed providers to be reimbursed by Medicare for services performed by RAs in the office setting.” False. The action by CMS was nowhere as broad as they describe it. The 2019 rule modification provided for payment for the technical component of Level 3 fluoroscopic-guided tests performed by RAs who were authorized by state law and supervised under the direct, rather than the personal, supervision of a physician. It did not provide broad performance, writ large, of RA services. Note also that RA authorizing laws providing for RA licensure under defined scope of practice rules exist in only about two thirds of the states.

The press release also noted that the 2019 Medicare rule change did not include reimbursement by Medicare for RA services performed in the hospital setting, when in fact Medicare guidance authorizes direct rather than personal supervision of RA performance of Level 3 diagnostic tests for Medicare hospital outpatients under the same conditions permitted for the office setting.

The proposed legislation is supported by the American Registry of Radiologic Technologists and the American Society of Radiologic Technologists. The American College of Radiology is neutral on the proposal.  In an article published on the new MARCA in Radiology Business, the co-executive director of the Radiology Business Management Association, Linda Wilgus, MBA, said that RBMA “looks forward to reviewing the legislation” and “collaborating with ARRT and ASRT on addressing critical workforce shortages.” The ultimate RBMA position may be critically important to MARCA's success or failure.

I believe that success for the legislation can occur only if the proponents talk truthfully about the current scope of Medicare regulations and enlighten their Congressional patrons about what existing Medicare rules actually mean.

In the meantime,  we should not lose focus on the need for scope of practice expansion in one-third of the states where statutes and rules don't appear to allow RAs to perform in a manner now permitted by Medicare supervision rules. My experience working with my radiologist clients leads me to believe they want to be able to make appropriate use RAs in their practice. MARCA, if enacted, may help with state scope of practice expansion, because MARCA implementation is dependent on state authorization of RA services.