Reading Room
Technical Resources for Medical and Radiation Oncology Practices
CMS Clarification of Physician Supervision
In this current update, CMS is further clarifying the CY 2010 physician supervision policies in response to additional questions and comments received since publication of the final rules.
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2010 Radiation Oncology Codes Professional Technical and Global Periods
This list contains CPT codes and descriptors commonly utilized to submit charges for procedures and services performed on oncology patients. Under the Medicare Physician Fee Schedule (MPFS) all CPT codes are assigned surgical, professional or technical rates. Also included are the global periods for each code. Please refer to the index at the bottom for an explanation of the global period.
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This IMRT Reference List is a compilation of journal articles that could be utilized to support medical necessity for delivering IMRT treatments to anatomical sites whose diagnosis code is not covered under your LCD.
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Electronic Prescribing Incentive Fact Sheet
Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA. This new incentive is separate from and is in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI).
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Medically Unlikely Edits for Physicians
Medicare has implemented a claims review process called Medically Unlikely Edits; MUEs. Medically Unlikely Edits were implemented to place limits on the frequency that individual codes could be billed. MUE edits are applicable only to a single provider to a single beneficiary on the same date of service. The goal of MUE edits is to reduce claims payment errors due to clerical entry mistakes or incorrect coding. If not addressed appropriately these MUE's can greatly affect your oncology revenue.
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Medically Unlikely Edits for Hospitals
Medicare has implemented a claims review process called Medically Unlikely Edits; MUEs. Medically Unlikely Edits were implemented to place limits on the frequency that individual codes could be billed. MUE edits are applicable only to a single provider to a single beneficiary on the same date of service. The goal of MUE edits is to reduce claims payment errors due to clerical entry mistakes or incorrect coding. If not addressed appropriately these MUE's can greatly affect your oncology revenue.
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Mutually Exclusive Edits for Physicians
CMS developed the NCCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Medicare Part B claims. The coding policies are based on coding conventions defined in the American Medical Association's (AMA's) Current Procedural Terminology (CPT) Manual, Healthcare Common Procedure Coding System (HCPCS) Manual, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice. NCCI edits are updated quarterly.
Click here to read the full article.
Mutually Exclusive Edits for Hospitals
CMS developed the NCCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Medicare Part B claims. The coding policies are based on coding conventions defined in the American Medical Association's (AMA's) Current Procedural Terminology (CPT) Manual, Healthcare Common Procedure Coding System (HCPCS) Manual, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice. NCCI edits are updated quarterly.
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Column 1/Column 2 Edits for Physicians
CMS developed the NCCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Medicare Part B claims. The coding policies are based on coding conventions defined in the American Medical Association's (AMA's) Current Procedural Terminology (CPT) Manual, Healthcare Common Procedure Coding System (HCPCS) Manual, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice. NCCI edits are updated quarterly.
Click here to read the full article.
Column 1/Column 2 Edits for Hospitals
CMS developed the NCCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Medicare Part B claims. The coding policies are based on coding conventions defined in the American Medical Association's (AMA's) Current Procedural Terminology (CPT) Manual, Healthcare Common Procedure Coding System (HCPCS) Manual, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice. NCCI edits are updated quarterly.
Click here to read the full article.
Today's reimbursement environment is what many would consider volatile. Physicians and administrative leaders are sometimes criticized by clinical personnel for being more in-tune with the reimbursement world than is felt to be necessary. The expenditures for advanced technology and the latest cancer drugs, in addition to the cost of experienced health care providers, necessitate that leadership keep a constant eye on the economics of cancer treatment and the world of reimbursement.
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Reimbursement and Revenue Generation
The recent years have brought about a very cost-conscious environment in radiation oncology. Many hospitals and physicians are trying to curb costs and some are even bringing in consultants that specialize in streamlining efficiencies in operations to reduce operational expense.
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The Push Toward Quality & Efficiency
CMS continues to steer physicians and facilities down one road; consistent quality care, delivered efficiently with proven technologies warranted for each individual patient.
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Planning For Your New Cancer Center
Cancer center design, whether hospital- or practice-based, requires the expertise and leadership of professionals who are highly experienced in not just the delivery of patient-focused clinical care but critical aspects of design and construction. Ultimately, space planning affects the quality of life of cancer patients and empowers everyone involved in helping healing thrive.
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Electronic Access to Health Records
With the signing of The American Recovery and Reinvestment Act, President Obama has dedicated $19.2 billion dollars towards promoting health information technology. One of the areas to be addressed is the implementation of Electronic Health Records (EHR) in every medical facility across the United States. It is important to stay abreast of the legislative actions and the impact this will have on every one by 2014.
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Financial Assistance: It Is More Available Than You Might Think
In an effort to assist clients and the oncology community in general, we have for some time been researching alternate sources of reimbursement for patients struggling to make payments on their care. Our experience is that most patients feel an obligation to pay their provider and genuinely want to make their debt whole. A list of resources are provided that will ease, if not alleviate, a portion of your patients concerns.
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