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.

June 2015 Radiation Oncology News (View More News and Articles)

Proposed Rule Time is Right Around the Corner. Are You Ready?

By Trena Taylor BA, R.T. (R)(T), CPC

Summer is here and that means the MPFS and HOPPS Proposed Rules release is nearing. It’s time to gear up and get ready for what’s coming down the pipe. Perhaps you’ve never heard of or read the MPFS and HOPPS Proposed Rules, or think they have no bearing on the oncology industry. If that’s the case, we urge you to think again! Consider taking a look at these very important publications this year and perhaps even getting involved in their process.

What is a proposed rule? Per the Office of the Federal Register, “The proposed rule, or Notice of Proposed Rulemaking (NPRM), is the official document that announces and explains the agency’s plan to address a problem or accomplish a goal.”

Each year the Centers for Medicare and Medicaid Services (CMS) issues a proposed rule for MPFS and HOPPS outlining proposed changes and goals for the upcoming year. Once the proposed rules have been published, a comment period begins—30 or 60 days—followed by the release of the MPFS and HOPPS Final Rules in the fall.

Why are the MPFS and HOPPS Proposed Rules important to the oncology industry? These publications outline important information regarding proposed changes to guidelines and reimbursement for healthcare. The vital information presented within these proposed rules is crucial to the future of oncology services. Remember, as the title indicates, the changes and goals proposed to address problems are just that: proposed. Every proposed rule is required to be followed up by a comment period. This is where individuals and groups in the oncology industry become very important.

Providing comments and alternatives during the comment phase has proven to be effective in past rulemaking, as final rules are indeed affected by those comments. For example, last year a proposal was made to change the treatment vault to an indirect practice expense, which would have likely decreased the payment for treatments. However, upon reviewing input given during the comment period, it was decided the treatment vault would remain a direct practice expense.

Who has the desire or the knowledge base to scour these documents for bits and pieces of information vital to radiation or medical oncology? It’s not likely the everyday radiation therapist, dosimetrist, physicist or even oncology administrator wants to even attempt this task. Did we mention that the document is traditionally released around the July 4th holiday? To boot, the publication covers nearly all specialties of healthcare. A professional who knows what to look for can extract extremely vital information specific to oncology. But reading the document word for word is an almost impossible task for someone looking for specific information on a specialty such as medical or radiation oncology. With the right tools and techniques, of course, the document could be scoured for specific information unique to only these specialties. But, for example, to find information on brachytherapy, one would have to be familiar with the specialty and its common terms as well as the CPT® codes associated with the service.

So, we’ve established that the proposed rules are important, but not just anyone has the time, energy or background to read, digest, relay and provide comments on the proposed rules. Because extracting and understanding the information important to the oncology industry is vital, Revenue Cycle Inc. has, over many years, developed and perfected a process for doing just that. Each year, around the beginning of June, our team gears up for the release of the MPFS and HOPPS Proposed Rules. As the rules are published, we dive in and scour the information for items vital to the oncology industry. Once we process the material, our team of experts then transfer the most important information, developing the most comprehensive—yet understandable—copy of the proposed rule specific to oncology. This review is delivered to clients and presented via webinar for anyone who wants a full explanation of the information extracted. Upon information delivery, each recipient will be fully informed of proposed changes and know how and when to make comments on the proposals.

In light of the changes that came about during last year’s final rule that resulted in a treatment delivery and IGRT coding nightmare, this year’s proposed rules should be interesting. To get the best proposed rule information for the upcoming year, register for the upcoming Proposed Rule Webinar by clicking here. If you don’t want the condensed versions of the proposed rules but want the full version, find them on the Federal Register website by clicking here. Keep in mind, though, that there is no warning or notice of their release until the minute it happens, so you’ll have to check the website daily and often.

Along with keeping you up-to-date on changes in healthcare rules and policies, Revenue Cycle Inc. can help make sure your voice is heard when it comes to proposed changes that can eventually affect you. We’ll provide clear, concise, digestible information detailing upcoming proposed changes and guide you through the process of influencing outcomes by providing effective input to decision makers. Find out more about our training and education programs—and all of the consulting services Revenue Cycle Inc. offers—by contacting our team at 512-583-2000 or info@revenuecycleinc.com.

June 2015 Medical Oncology News (View More News and Articles)

HCPCS Drug/Biological Code Changes for Biosimilars

By Gigi Price, R.N., O.C.N., CHONC

Throughout the year, CMS releases quarterly code changes by way of the Medicare Learning Network®. Here’s a summary of how to submit the new code for the biosimilar drug Filgrastim (G-CSF).

MLN Matters® Number: MM9167 Related Change Request (CR) #: CR 9167 
Related CR Release Date: May 8, 2015; Effective Date: July 1, 2015 
Related CR Transmittal #: R3254CP; Implementation Date: July 6, 2015

Effective for Claims with Dates of Service On or After: HCPCS Code Long Description Short Description Type of Service (TOS)
March 6, 2015 Q5101 Injection, Filgrastim (G-CSF), Biosimilar, 1 microgram Inj filgrastim g-csf biosim 1, P

 

The drug Zarxio (filgrastim-sndz) is classified as a biosimilar. It is approved for all indications included in its reference product's (Neupogen®) label. Zarxio is a trademark of Novartis AG, is manufactured by Sandoz Inc. and is available in two prefilled sizes:

Injection: NDC 61314-304-01 300 mcg/0.5 mL in a single-use prefilled syringe 
Injection: NDC 61314-312-01 480 mcg/0.8 mL in a single-use prefilled syringe 

Changes in coding are constant and making sure that you apply specific payor guidelines is an important step in your documentation and billing compliance plan. The team at Revenue Cycle Inc. specializes in staying abreast of CMS news and more. We’ll make sure your staff is educated on the latest coding updates, trained to ensure proper documentation and implement effective checks and balances so that you can achieve your compliance goals. For more information regarding Revenue Cycle Inc.’s services, please contact our consulting team at 512-583-2000.