What are the most common pitfalls that result in poor reimbursement?
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A successful CCTA implementation requires a fully comprehensive program from evaluation to discharge and disposition. A key benefit of CCTA is lower downstream layered testing and increased identification of patients with potential benefit from risk factor modification and lifestyle changes if coronary atherosclerosis is identified. A successful program starts with understanding local coverage by CMS, VA and Tricare as well as all other government agencies and local payers. Coverage may vary by state as well as individual insurance contracts though national health coverage for the payer might be extensive.

Elements of a successful program include:

  • Understanding the local coverage and the indications covered.
  • The patient demographics and flow to assess whether the prevalence of disease and current local population supports the business case for CCTA purchase.
  • Having in place a process improvement program with quality metrics focused on patient radiation reduction and preventive measures to meet the reimbursement quality metric for that category.

SCCT is leading the way to standardize the approach to building a CCTA program, coverage and reimbursement method for programs that provide high quality care with excellent metrics.



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