Relevant, Timely Medical and Radiation Oncology News

Constant advancements medical technology and healthcare regulations mean the oncology industry is dynamic and fast-changing. To keep clients on the leading edge of what's happening, Revenue Cycle Inc. maintains the news section of its website as a clearinghouse for oncology news, CPT® coding and/or business operations. Whether it's a legal change that could affect our industry or a tip about oncology coding, you'll find it here.

For more information about how our team of expert consultants can help your practice stay current on these industry changes, visit our medical and radiation oncology service page.

April 2014 Medical Oncology News (View More News and Articles)

Second Quarter ASP Update

By Gigi Price, RN, OCN, CHONC

As the season changes and the first quarter of 2014 has come to a close, we’d like to remind you that it’s time to review the quarterly Average Sales Price (ASP) Payment Allowance Limits for Medicare Part B Drugs for reimbursement and possible code changes. The ASP quarterly payment file is provided by the Centers for Medicaid and Medicare (CMS) and can be found by clicking here

In this publication, CMS indicates that average drug prices have remained stable and prices for the top Part B drugs have increased by 1.7 percent while the higher-volume drugs changed by 2 percent or less. Payment amounts in these files are 106 percent of the ASP, calculated from data received by drug manufacturers. These variances in pricing are generally tied to this updated data from drug manufacturers. CMS states that they will continue to focus on beneficiary access to Part B covered drugs and therefore continue to monitor trends in pricing and utilization.  

In addition to pricing changes, the second quarter includes new HCPCS codes added to the ASP file with an effective date of April 1, 2014.

As always, new codes mean that the potential for coding and billing errors increases. CMS recommends a quarterly review of these types of changes. Regarding accurate billing of drugs and drug units:

CMS guidance requires physicians and other providers to bill using the appropriate HCPCS or CPT code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy.

Like CMS, Revenue Cycle Inc. recommends that you review and update charge masters on a quarterly basis to identify possible reimbursement changes that may affect your practice. It’s also important that your departmental and billing staff are trained on these updates and code changes—including a review of billing and pharmacy inventory systems—to ensure accurate coding of drugs and drug units. As you know, the potential negative effects that can result from your staff not complying with code changes can be serious.

Revenue Cycle Inc. can help you mitigate this risk. We’ll provide you and your staff comprehensive training on code changes, their potential impact on your practice and the appropriate billing processes to accommodate for these changes. Let us keep your practice up-to-date and running smoothly. For information on how we can help, contact us at 512-583-2000 or info@revenuecycleinc.com.

April 2014 Radiation Oncology News (View More News and Articles)

Don’t Miss a Claim—Update Your Forms by April 1

By Stephania Rodriguez

Physicians, physician offices and freestanding facilities use a claim form commonly referred to as a CMS 1500 Claim Form. A new version of this form has been made available—the revised 1500 claim form, version 02/12—and as of January 6, 2014, Medicare began accepting it. Medicare will continue to accept claims made with the previous 08/05 version of the 1500 claim form through March 31, 2014. However, beginning April 1, 2014, Medicare will only accept paper claims on the revised CMS 1500 claim form, version 02/12.

The revised 1500 claim form, version 02/12 has new indicators. These new indicators give more information to the claims payor about the service performed. They can be found in items 17, 21 and 24E on the new form.

In item 17, enter one of the following qualifiers as appropriate to identify the role this physician (or non-physician practitioner) is performing:

Qualifier              Provider Role
DN                        Referring Provider
DK                        Ordering Provider
DQ                        Supervising Provider

In item 21, it may be appropriate to report either ICD-9-CM or ICD-10-CM codes, depending on the dates of service and effective dates of the code sets given. Both ICD-9 and ICD-10 cannot be reported on the same claim form. For each claim, the appropriate indicator must be used to indicate the diagnosis coding set used in the claim. Up to 12 diagnoses can be applied to this section.

Indicator              Code Set
9                            ICD-9-CM
0                            ICD-10-CM         

In item 24E, the letter of the diagnosis code reference number found in item 21 will be placed on each line of the service being claimed. This relates the date of service and procedure with the most appropriate diagnosis code on each claim. Only one diagnosis code reference number will be applied.   

Sample

For more information on this CMS update, click here.

For instructions on the revised 1500 claim form, version 02/12, click here.

For a sample of the revised 1500 claim form, version 02/12, click here.

With this upcoming deadline, it’s a priority that your staff is up-to-date and educated on using the appropriate forms and that your office correctly implements new procedures for any claims performed. We can help. Revenue Cycle Inc.’s consultants can conduct assessments and provide training on claims best practices to help ensure compliance. And through our Client Resource Center, we offer oncology providers and practices ongoing support—with access to our experts all year—whenever questions arise. If you’d like more information regarding our consulting services, contact us at info@revenuecycleinc.com.