E2455. Reading in the Real World: A Compliance Primer for Radiology Residents
  1. Millie Yu; Montefiore Medical Center
  2. Kristen Lee; Montefiore Medical Center
  3. Judah Burns; Montefiore Medical Center
  4. Amichai Erdfarb; Montefiore Medical Center
Healthcare compliance is the continuous process of abiding by ethical, legal, and professional standards to improve patient care. Knowledge of key compliance issues in radiology is important at all levels, including for trainees. Compliance governs policies, processes, and procedures on a daily basis; understanding these entities is key adhering to required standards and maintaining a high level of patient care.

Educational Goals / Teaching Points
The goal of this presentation is to summarize key compliance issues in radiology, with a focus on resident-level understanding and application to practice management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Specific educational topics will highlight the role of regulations in patient billing and everyday practice, tying in the financial and logistical aspects of radiologic patient care that trainees may otherwise not consider. We will clarify who is able to order a diagnostic test and who may modify orders; discuss factors trainees must consider when protocolling studies to fit clinical scenarios; explain billing for procedures performed by trainees; clarify rules for physician coverage for contrast injections; explain the Stark Law and practice its implications for practices to which providers may send reimbursable referrals; consider patient-centered aspects of immediate patient access to radiology reports in light of the 21st Century Cures Act; and describe nuances of out-of-network billing relevant to the No Surprises Act.

Healthcare compliance impacts all aspects of radiology practice. Comprehensive knowledge of relevant laws and regulations is needed to assure compliance with relevant statutes, to align with clinical practice standards, and protect radiology practices against complaints of fraud and abuse. Trainees must understand these issues in order to develop practice patterns satisfying required local, regional, and federal standards. Recognizing basic standards of evolving healthcare compliance empowers trainees to best direct their evolving role in a complex patient care environment.