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.

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

Bills Introduced in Congress to Delay ICD-10 Implementation

By Teri Bedard BA, R.T.(R)(T), CPC

As we get closer to the ICD-10 implementation date of October 1, we’re continuing to see a push for delaying or outright canceling the transition from ICD-9. House representatives recently introduced two bills for consideration. The first bill was H.R. 2126, the Cutting Costly Codes Act of 2015. It would prohibit the Department of Health and Human Services from implementing, administering or enforcing regulations that would replace ICD-9 with ICD-10. The Government Accountability Office (GAO) must recommend steps to mitigate the disruption to health care providers that would result in the replacement of ICD-9. 

Introduced by Texas Rep. Ted Poe to the House on April 30, this bill is similar to the one he introduced in 2013 when ICD-10 was scheduled to be implemented in 2014. After introduction, the bill was sent to the Committee on Energy and Commerce and the Committee on Ways and Means. 

If either committee chooses to debate H.R. 2126 and add any amendments to it for vote, it could be sent to the House, but it has to get past the committees first. Since Rep. Poe is not on either committee, he would need to find someone who is a member of either one to back and support his proposed bill. In February, the Committee on Energy and Commerce held a conference on ICD-10 with several senior level members in support, so it is unlikely this bill will be overturned.

Another bill, H.R. 2247, the ICD-TEN Act, was introduced by Rep. Diane Black of Tennessee on May 12. This bill was also sent to the Committee on Energy and Commerce and the Committee on Ways and Means. H.R. 2247 would require CMS to perform comprehensive testing of ICD-10 codes and report back to Congress with the results. CMS has already begun several series of end-to-end testing, which have been successful. This bill, however, would require an implementation period of 18 months. As indicated in the bill, “(b) Safe Harbor. - During the implementation period described in subsection (a), no claim submitted for payment under title XVIII of the Social Security Act by a health care provider pursuant to the ICD–10 standard medical data code sets shall be denied due solely to the use of an unspecified or inaccurate subcode.” What this means, essentially, is that for 18 months following the implementation of ICD-10, no claim could be denied based on the use of incorrect coding of the diagnosis alone. 

As of this time neither bill has made it out of committee and sent to the House for final vote.

Stay abreast of healthcare updates from Washington D.C. with the help of Revenue Cycle Inc. Our expert consultants are plugged in to the latest news, and we can apply the specifics of policy changes to your practice’s day-to-day operations and long-term planning. To learn more about how Revenue Cycle Inc. can help, please contact our team at 512-583-2000 or info@revenuecycleinc.com.

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

CY2016 Proposed Rules for Radiation Oncology Released

The CY2016 Proposed Rules for Radiation Oncology contained many potential changes to the Medicare Physician Fee Schedule including the proposed conversion factor, practice expense and malpractice updates, misvalued codes, radiation treatment and related image guidance services and more. Hospital Outpatient Prospective Payment System highlights are comprised of changes to the payment rates, APC names/codes, C-APC for SRS procedures and the new HCPS codes to be released in August. The Revenue Cycle Inc. team has thoroughly reviewed and condensed the proposed changes for the radiation oncology industry into two documents. Within these summations are examples of potential reimbursement based on the interpretation of the published ruling. To read the summaries, click on the links below to download a PDF.

CY2016 Proposed Rule for Radiation Oncology – MPFS

CY2016 Proposed Rule for Radiation Oncology – HOPPS

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

CY2016 Proposed Rules for Medical Oncology Released

According to the recent release of the CY2016 Proposed Rules for Medical Oncology, highlights of changes to the Medicare Physician Fee Schedule include adjustments to the conversion factor, misvalued codes and payment for biosimilar biological products. The Hospital Outpatient Prospective Payment System focal points consist of, but are not limited to, changes in the OPPS payment rates for both rural and community hospitals, packaging policies, the conversion factor, payment changes for drugs, biologicals and radiopharmaceuticals and more. The Revenue Cycle Inc. team has comprised a summary of the proposed changes for the medical oncology industry into two documents. To read the summaries, click on the links below to download a PDF.

CY2016 Proposed Rule for Medical Oncology – MPFS

CY2016 Proposed Rule for Medical Oncology – HOPPS

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.