The purpose of this communication is to offer suggestions to member radiologists as to how to develop a radiology advisory committee to foster effective communication between the radiology community and payers.
As the complexity and sophistication of the practice of radiology has increased, so has the importance of maintaining a positive and constructive relationship with all payers. Ask any radiologist about this, and he or she will no doubt have many examples of claims denials because of a lack of understanding in the insurance industry as to how radiologic procedures are performed and how new technology evolves for the patient’s benefit. Even in the Medicare system, problems and difficulties arise at the carrier level when communication between the specialty and the payer is inadequate or nonexistent.
Medicare has an obligation to meet with representative physicians from the various specialty societies through the Carrier Advisory Committee, better known as the CAC. Meeting quarterly, the CAC serves as the clearinghouse for the discussion of Medicare policy at the carrier level as well as offering a forum for the free and open discussion of other issues concerning payment and provider education. A very successful program, the CAC network is a valuable and effective venue.
Its drawback, of course, is that it is not specialty-specific. Over 25 specialties are represented at CAC meetings and there is often little time to accomplish the detailed discussions so often associated with radiology presentations. The non-Medicare payers are under no such mandate to meet with physician representatives and usually have not established physician advisory committees. For these companies, policy decisions are usually channeled through a medical director. The director is often a generalist and is almost never a radiologist, and likely will have little familiarity with new technology and other radiology issues. Thus, it is invaluable to have a radiology advisory committee available to meet periodically with both Medicare and non-Medicare payers.