Reimbursement a Problem for Reads by Board-eligible Radiologists

For radiologists leaving residency and going into practice or fellowship, getting a job is a big concern. As we covered in our recent article Are Board-Eligible Radiologists at a Disadvantage? the job market is tight and the class finishing residency in July was the first to move on without board certification. The certification process paradigm change means they can’t take the final test for another 14 months.

In our article, residents expressed concern that this could impact their full time and moonlighting job prospects, since some private payers won’t reimburse for image interpretation or final reads by board-eligible radiologists. These fears appear to be valid.

There are indeed insurance carriers that don’t allow board-eligible radiologists to read their cases, said Steven L Mendelsohn, MD, chief executive officer of Zwanger-Pesiri Radiology in Long Island, NY. He was referring specifically to CareCore.[[{"type":"media","view_mode":"media_crop","fid":"27345","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_2057139030558","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2643","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 118px; width: 150px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

“CareCore, which manages reimbursement for multiple carriers, will not allow [board] eligible radiologists to read any of the studies, unless reviewed and consigned by a board-certified radiologist. Since hospital practices do not face the same credentialing issues, none of them will raise this issue. However non-hospital private practices such as mine will be completely unable to hire any of these newly trained board-eligible radiologists,” Mendelsohn said. Zwanger-Pesiri’s practice currently has 55 radiologists.

What are the prospects for radiologists who can’t get positions at practices with contracts restricting billing to only those who are board-certified? “Ultimately these young newbies will provide a cheap, perhaps abused labor pool for the hospitals, who may be reveling in the inability for these young individuals to join private practices,” Mendelsohn said.

Zwanger-Pesiri just hired six newly graduated board-certified fellows, but “it may be a very different story for anyone we hire finishing fellowship July, 2015.” Those fellows will only be board-eligible.

Does your hospital or private practice contract currently have similar restrictions, limiting billing to board-eligible radiologists? Please share your thoughts in the comments section below.