Imaging Services Steerage Programs

The payer community’s need for medical cost containment has been recognized for more than twenty years. Payers have frequently implemented programs to control the utilization and the cost of high technology imaging modalities, primarily magnetic resonance, computed tomography, nuclear medicine and nuclear cardiology studies, performed in the hospital outpatient, physician office and free-standing imaging center settings. These utilization management programs, whether internally managed or outsourced to a Radiology Benefit Management company (RBM), typically use some combination of medical need determination and pre-authorization or pre-notifications strategies. Once the imaging study is authorized, Imaging Services Steerage Programs (ISSP) attempt to direct the patient to “preferred imaging providers.”