Medicare reimbursed only about 47% of radiology SaaS AI claims between 2018 and 2023, denying over $16 million in payments.
Key Details
- 1From 2018–2023, radiologists received $8 million in Medicare payments for SaaS AI, but $16.4 million worth of claims were denied.
- 2A total of 83,392 AI services were submitted; 47.4% (39,535) were approved, 52.6% (43,857) denied.
- 3CT-derived fractional flow reserve accounted for 90.7% of accepted services and $7.8 million in reimbursements.
- 4Adoption and denied claims both increased annually: 1,507 services submitted in 2018 rose to 53,586 in 2023.
- 5Accepted services were most common in on-campus outpatient settings (61.3%) and physician offices (32.2%).
- 6Reasons for claim denials remain unclear; reimbursement relies on mixed national and local policy determinations.
Why It Matters
Understanding reimbursement patterns is crucial for radiology practices to evaluate the return on investment for SaaS AI solutions. The discrepancy in coverage highlights ongoing challenges in integrating AI into clinical workflows and underscores the need for clearer policies to encourage adoption.
Source
AuntMinnie
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