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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.
March 2014 Radiation Oncology News (View More News and Articles)
Will the OIG Work Plan for 2014 Impact Oncology Practices?
By Tamara Syverson, BSRT(T)
On January 31, 2014, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released their Work Plan for FY 2014. This Work Plan provides a description of the new and ongoing reviews that OIG plans to pursue regarding HHS programs and operations this fiscal year and beyond.
The OIG was created to protect the integrity of HHS programs and operations as well as the well-being of their beneficiaries by detecting and preventing fraud, waste and abuse. It also identifies opportunities to improve program economy, efficiency and effectiveness and holds accountable those who do not meet program requirements or who violate Federal Law.
The OIG mission encompasses more than 300 HHS programs, including the Centers for Medicare & Medicaid Services (CMS) and the Work Plan is developed based on emerging issues and the assessment of risk of the associated programs.
The success of the Work Plan and the OIG efforts are demonstrated by their accomplishments published for FY 2013. The OIG has reported expected recoveries of more than $5.8 billion, which consists of approximately $850 million in audit and $5 million in investigation findings. The full document can be found on the OIG website by clicking here.
The Work Plan for FY 2014 encompasses a variety of existing and newly identified issues associated with Medicare Part A and Part B. Within these defined areas, concerns related to practices within the medical and radiation oncology specialties are evident, including but not limited to the following reviews:
- Reconciliations of outlier payments
- Impact of provider-based status on Medicare billing
- Comparison of provider-based and freestanding clinics
- Outpatient evaluation and management services billed at the new-patient rate
- Bone marrow or stem cell transplants
- Oversight of pharmaceutical compounding
- Oversight of hospital privileging
- Evaluation and management services—inappropriate payments
- Physicians’ place-of-service coding errors
- Manufacturer reporting of average sales prices for Part B drugs
- Comparison of average sales prices to average manufacturer prices
- Part B payments for drugs purchased under the 340B Program
- Payments for outpatient drugs and administration of the drugs
The OIG also reviews Part A and Part B contractors, as they are integral in the administration, management and oversight of HHS programs. These reviews are conducted by the Medicare Administrative Contractor (MAC), as well as by other contractors engaged to combat fraud, waste and abuse. Reviews defined in this area include:
- Medicare administrative contractors—use and evaluation of local edits
- Medicare benefit integrity contractors’ activities
- ZPICs and PSCs—identification and collection status of Medicare overpayments
In addition, the OIG has defined a focus on information technology (IT). Specifically, this includes the security of portable devices that contain personal health information as well as networked medical devices, such as medication dispensing systems integrated into electronic medical record systems and larger health networks. In light of recent data breaches experienced by major, well-known retailers, it’s likely that the security of sensitive information such as protected health data will continue to be scrutinized so that the HHS beneficiaries’ security and privacy can be ensured.
Based on the OIG’s published reviews and similar reports issued by other Medicare and Medicaid program integrity contractors, we know that attention to billing and documentation compliance cannot be overlooked. While fraud is associated with intentional wrongdoing or malicious behavior, simple errors, oversights or failure to follow updated requirements and guidelines can potentially escalate into larger concerns. Revenue Cycle Inc. can help you identify potential risks for various areas of your oncology practice and recommend solutions, including medical record reviews and staff education. Revenue Cycle Inc. can also help you identify and maintain up-to-date, efficient resources and processes for oncology coding and documentation. For more information regarding Revenue Cycle Inc.’s services, please contact our consulting team at 512-583-2000 or firstname.lastname@example.org.
February 2014 Medical Oncology News (View More News and Articles)
Neupogen® (Filgrastim) HCPCS “J” code changes for 2014
By Gigi Price, RN, OCN, CHONC
Neupogen® is a drug commonly used in the medical oncology setting prophylactically to prevent neutropenia—white blood cell counts dropping to critical values—during the course of treatment with some chemotherapeutic agents. Some chemotherapeutic agents destroy good cells as well as malignant cells; for example, by decreasing the production of neutrophils, a type of white blood cell that helps the body fight infection. Neupogen stimulates bone marrow to produce neutrophils. Neupogen may also be used to treat febrile neutropenia, which may occur when the white blood cell count drops and an infection may be present after initiation of chemotherapy.
Several other uses of Neupogen include treatment of patients receiving bone marrow transplants, stimulation of peripheral stem cells to prepare for the harvesting step for transplants, therapy induction or consolidation chemotherapy, and treatment of patients with severe chronic neutropenia.
In past years, Neupogen was billed with HCPCS codes based on the complete dose J1440 Neupogen 300mcg or J1441 Neupogen 480mcg. These were both billed per 1 unit (dose). Starting January 1, 2014, HCPCS code J1442 was assigned to Neupogen to be billed per 1mcg. This change in the reporting of Neupogen means there’s potential for incorrect reporting of the appropriate HCPCS code and the associated units. To avoid mistakes, it’s important to make sure that staff are informed and trained, and that coding updates are reviewed and implemented on a quarterly basis.
In a hospital outpatient setting, the J1440 code will billed on the UB-04 claim form. On this form, enter the appropriate revenue code (0636) in Locator Box 42, the description corresponding to the HCPCS code, Neupogen (Filgrastim) in Locator Box 43, the J1442 HCPCS code in Locator box 44 and the appropriate number of service units within Locator Box 46. For example, enter 300 for a single 300mcg dose or 480 for a single 480mcg dose.
In a physician office setting, the code will be billed on the CMS 1500 claim form. The HCPCS code J1442 will be entered in Locator Box 24D and the number of service units in Locator Box 24G, similar to the example above—300 for a single 300mcg dose or 480 for a single 480mcg dose.
The table below indicates Medicare ASP allowable for the codes J1440 and J1441 for CY 2013 along with the allowable for the new J1442 code for CY 2014.
Revenue Cycle Inc. provides comprehensive education on code changes, their potential impact on your practice and the appropriate billing processes that accommodate 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.