Better support helps cardiac PET providers overcome reimbursement hurdles

Nearly 700,000 people in the United States died from heart disease in 2020, according to the Centers for Disease Control and Prevention. Cardiac PET is an imaging modality that helps diagnose heart disease with efficiency and certainty which is imperative for developing and implementing effective treatment plans. But patient access to cardiac PET can be curtailed if providers can’t get reimbursed for the procedure. Brande Plotnick describes how Bracco’s new reimbursement support program can help the company’s 500-plus cardiac PET imaging sites overcome their hurdles with reimbursement.

Getting started with cardiac PET requires upfront investment. Providers must have access to a PET/CT scanner and have knowledgeable staff to perform the procedures. The most successful sites also invest heavily in people who are knowledgeable about coding and billing third party payers. To maintain their imaging program, providers must have a sufficient volume of patients and appropriate payments from insurance payers and health plans. Reimbursement is imperative for patient access. If the practice isn’t getting reimbursed for their cardiac PET procedures, the program will not remain viable. This leaves patients in the community without access to cardiac PET, the imaging modality considered by many to be the gold standard in diagnosing heart disease.

What are the biggest challenges cardiac PET providers face with reimbursement?

Reimbursement is challenging because payer policies can change arbitrarily and without warning to providers, and there are different requirements across the many different payers across the country. Success feels like a moving target. Local payers often have different coverage criteria and prior authorization requirements for a cardiac PET study, such as requiring a certain body mass index or weight threshold. When sites have claims denied or when they have trouble getting prior authorizations for their patients, it makes it frustrating and can impact the financial viability of the program.

How is Bracco addressing these reimbursement issues?

Bracco trains our field-based Nuclear Medicine Account Managers and Clinical Applications Specialists to be experts in the national and local reimbursement landscape. They are the first line resource for our sites when they have questions about third-party payment or health policy related to cardiac PET imaging. To supplement their work and make our support even more tailored to the local payer landscape, Bracco enlisted the help of the Palomino Group, a company that has expertise in reimbursement, to offer the Bracco Cardiac PET Reimbursement Support Program. We connect our customers and their billing departments to the Palomino Group, which offers a dedicated full-time employee to help them with their reimbursement issues.

The program was pilot tested early in 2022, and the feedback from our customer sites was overwhelmingly positive. One group reported that because of the help they received, they will see a significant improvement in appropriate reimbursement and patient access to cardiac PET while also learning skills that will help them in the future. Appropriate reimbursement is just one goal of the program. We want to help our sites overcome short-term challenges quickly, and we also want to help them learn strategies for getting even better at what they do as a practice. It’s about driving excellence and patient access to cardiac PET imaging in a new way, something to which Bracco has long been committed.

Once we introduce the key billing personnel at our customer sites to the Palomino Group through an introductory call, Bracco is hands off. Their wonderful and approachable staff communicate directly with the cardiac PET customers and helps them with their specific payer challenges, patient pre-authorizations or denials.

Who is eligible for this support?

This program is now freely available to all Bracco cardiac PET sites. We currently have dozens of sites on the program, and that number is climbing each week. Not every site needs the program, but sites that experience considerable and unique challenges with patient access could use some extra support. If a site has ongoing challenges and questions, they’re going to get ongoing help.

How will the new program benefit providers and their patients?

When reimbursement issues are left unresolved, patient access to important diagnostic procedures and therapies is threatened. Heart disease is the biggest health problem in our country, and kills more people than any other condition. Bracco believes all patients should have access to the best diagnosis and care for heart disease, whether they live in a remote rural area or within walking distance to a prestigious imaging center in a major city. We are a true partner for our customer sites and we want our sites to be successful because when they are, more patients have access to cardiac PET. Helping our providers give the best care to patients has always been what drives us at Bracco.