A very pertinent topic, which the Brazilian College of Radiology and Image Diagnosis receives several consultations, deals with the obligation of health operators to adopt the code and nomenclature of the Unified Terminology of Supplementary Health (TUSS).
Some operators have adopted descriptions of procedures that deviate from the TUSS standard, negatively impacting radiologists, sometimes causing a reduction in values, others forcing them to perform more procedures for the price of just one procedure.
These alterations are usually noticed in the reduction of amounts paid and unjustified glosses in authorized procedures performed by radiologists. Queries are diverse, but most are related to changes made in the last three years.
To act in this scenario with the objective of combating this practice, the clinic must know and understand its rights, that is, the regulations of the National Supplementary Health Agency (ANS).
“Our experience has been positive in the dialogue with health operators when we formally question, based on ANS regulation. If there is disagreement with the healthcare provider regarding the applicability of the ANS regulation, we suggest that the clinic make a formal consultation with the CBR and share it with the healthcare provider. If there is insistence, we recommend suggesting to the health operator that both make [together] a formal consultation with the ANS”, complements Carlos Moura, CBR's economic advisor.