Presented at the Nov. 17, 2014 Annual Meeting
RADIOLOGY'S ROLE IN
ALTERNATIVE PAYMENT MODELS

EZEQUIEL SILVA, III, MD, FACR
Vice-Chair, Commission on Economics
American College of Radiology


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The Radiologist functions in a larger environment governed on the state and federal levels. The Radiological Society of New Jersey plays a key role in creating and maintaining a rewarding environment to practice Radiology in New Jersey. As the practice of Radiology becomes busier, the relationship between the RSNJ and various governmental agencies on the state and federal levels becomes increasingly important. The effort Radiologists put into training and into the daily performance of Radiology demand a favorable environment in which to work. The Radiological Society of New Jersey is instrumental in providing and maintaining this environment.
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The RSNJ also provides opportunities for practicing Radiologists to maintain and expand their expertise, by providing state of the art lectures given as part of our annual and semi-annual meetings.

Dues paid to the RSNJ are money well spent. Time given to the RSNJ is well worth the effort. Radiologists are encouraged to join the Radiological Society of New Jersey and to get involved in the workings of the RSNJ, for their own benefit as well as the benefit of all practicing Radiologists in New Jersey.

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Breast Density Toolkit

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BME Requirement for End of Life Care

RSNJ Letter to Horizon BC/BS Regarding
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The New Jersey Society of Plastic Surgeons celebrates
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To view the Radiological Society of New Jersey Breast Density Information web page, click the button below.

 

IMPORTANT UPDATE FOR RADIOLOGISTS:
Reporting Requirements for Radiologists
Effective May 1, 2014

New Jersey has become the 14th state to pass breast density notification legislation, joining the ranks of Alabama, California, Connecticut, Hawaii, Maryland, New York, Nevada, North Carolina, Oregon, Pennsylvania, Tennessee, Texas, and Virginia. The law will apply to all contracts and policies of insurance that are delivered, issued, executed or renewed or approved for issuance or renewal in New Jersey on or after May 1st.

The law, in relevant part, requires health insurers to provide health benefits coverage for an ultrasound evaluation, a magnetic resonance imaging (MRI) scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts, after a baseline mammogram examination, (1) if the mammogram demonstrates extremely dense breast tissue, (2) if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or (3) if the patient has additional risk factors for breast cancer, including but not limited to, (a) family history of breast cancer, (b) prior personal history of beast cancer, (c) positive genetic testing, (d) extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology, or (e) other indications as determined by the patientís health care provider. The additional testing may be subject to utilization review for medical necessity.

Most importantly and impacting your practice, effective May 1, 2014, a facility that provides a mammography report pursuant to the federal Mammography Quality Standard Act must include the following information, at a minimum, in the mammography report sent to the patient and the patientís health care provider:

Your mammogram may show that you have dense breast tissue as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology. Dense breast tissue is very common and is not abnormal. However, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with our health care provider. A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology, www.acr.org.

The bill provides that the information on breast density included in mammography reports will not impose a standard of care obligation upon a patientís health care provider. The law stipulates that the information in the report is intended to increase awareness of breast cancer and help facilitate a conversation between a patient and a patientís health care provider regarding the patientís risks for breast cancer.

The health benefits coverage requirements apply to health, hospital, and medical service corporations; commercial, individual, and group health insurers; health maintenance organizations; and health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs. The requirements for coverage also apply to the State Health Benefits Program, which by law requires similar health benefits coverage under the School Employeesí Health Benefits Program.

For additional information, contact:
John D. Fanburg, Esq.
jfanburg@bracheichler.com
(973) 403-3107
 

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