MedSolutions supports GAO recommendation for medical imaging prior authorization

July 23, 2008 -- With results of a recent study conducted by the Government Accountability Office (GAO) recommending prior authorization under Medicare Part B for high-tech imaging services, MedSolutions emphasizes the need for these radiology benefit management (RBM) services under both commercial and government-sponsored health benefits programs. MedSolutions, which manages radiology services for national and regional health plans, says it validates the role of effective RBM to lower costs, assure patient safety and generate improved health outcomes.

"The explosive growth of imaging has been a topic in the national dialogue on Medicare spending for years," states Curt Thorne, CEO of MedSolutions. "The GAO report recommending the introduction of RBM is a positive step. Given the fact that Medicare spending on medical imaging services in doctors' offices more than doubled to $14 billion from 2000 to 2006, we applaud this consideration of prior approval. Our commercial health plan and government clients across the country have found the approach to be highly successful in addressing cost challenges and we expect that Medicare can replicate these achievements."

The GAO found that advanced medical imaging services comprised a major driver of increased spending under the Medicare physician fee schedule for medical imaging. Last week, the Medical Imaging & Technology Alliance said that the GAO's report was skewed, citing the comments on RBM in particular.

MedSolutions says it relies upon clinical guidelines that are completely transparent in order to contain costs.

"Our understanding is that CMS [Centers for Medicare & Medicaid Services] was interested in understanding our administrative costs and whether RBMs operate with the level of transparency required in Medicare," says Thorne. "We are confident CMS can be satisfied on these matters. Our administrative costs are typically a small fraction of documented savings, and it is standard practice for us to operate with complete transparency with physicians and patients."

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