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 UCC the global fee for performing a radiology service at the UCC when one
of the following conditions is met.
(1) The
UCC 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 UCC employs a board-certified or
board-eligible radiologist to provide the professional component of the service
and the UCC subcontracts with a licensed Medicare-certified entity to provide
the technical component of the service.
(3) The UCC 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 UCC and the
licensed Medicare-certified entity must be in writing, ensure continuity of
care, and be consistent with all applicable provisions of 130 CMR
455.000.
(2) The UCC is legally
responsible to the MassHealth agency for the performance of any subcontractor.
The UCC 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: Administrative and Billing Regulations. The UCC 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 (see130 CMR 455.422), the UCC 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.
