From the July 2, 2007, issue of "The Gray Sheet"
An insurance company strategy to rein in perceived overuse of imaging services has gained traction in Congress for its potential as a Medicare cost-saver.
The approach: private payers contract with third parties to act as "gatekeepers" for imaging coverage. Radiology benefits managers (RBMs), as they are called, review physicians' imaging study orders, excluding inpatient services, for prior authorization before allowing coverage.
RBMs argue that inappropriate use of high-cost imaging services like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) happens too frequently and reducing it can increase quality of care and save significant money.
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