Current through Register 1531, September 27, 2024
(A)
Definitions.
Global Fee - the rate of payment for
the two components of a radiology service: the professional component and the
technical component.
Professional Component - the component
of a radiology service for interpreting a diagnostic test or image.
Technical Component - the component of
a radiology service for the cost of rent, equipment, utilities, supplies,
administrative and technical salaries and benefits, and other overhead
expenses.
(B)
Payment of the Global Fee. The MassHealth agency will
pay a CHC the global fee for performing a radiology service at the CHC when one
of the following conditions is met.
(1) The
CHC owns or leases the equipment for providing the technical component of the
service, employs a technician to provide the technical component of the
service, and employs a board-certified or board-eligible radiologist to provide
the professional component of the service.
(2) The CHC employs a board-certified or
board-eligible radiologist to provide the professional component of the service
and the CHC subcontracts with a licensed Medicare-certified entity to provide
the technical component of the service.
(3) The CHC subcontracts with a licensed
Medicare-certified entity to provide the professional and technical component
of the service.
(C)
Subcontracting for Radiology Services.
(1) All subcontracts between the CHC and the
licensed Medicare-certified entity must be in writing, ensure continuity of
care, and be consistent with all applicable provisions of 130 CMR
405.000.
(2) The CHC is legally
responsible to the MassHealth agency for the performance of any subcontractor.
The CHC must ensure that every subcontractor is licensed and
Medicare-certified, and that services are furnished in accordance with the
MassHealth agency's regulations including, but not limited to, those set forth
in 130 CMR 450.000. The CHC must submit claims for payment for radiology
services provided hereunder in accordance with the MassHealth agency's
regulations and applicable fee schedules.
(D)
Radiology Recordkeeping
(Medical Records) Requirements. In addition to complying with the
general recordkeeping requirements (see
130 CMR
405.412) , the CHC must keep records of
radiology services performed. All X-rays must be labeled with the following:
(1) the member's name;
(2) the date of the examination;
(3) the nature of the examination;
and
(4) left and right designations
and patient position, if not standard.
