Medicare Regulations to Have a Strong Impact on Oncology Sector; Here’s How

Medicare Regulations

Medicare Regulations are primarily controlled and evaluated over time by recognized agencies such as the Medicare Physician Fee Schedule (MPFS) and Protecting Access to Medicare Act (PAMA). Through the years, additive permutations and combinations are tested out in the forms of Medicare payment policies, to make the process of medical billing and EHR easier and streamlined.

Although there were fewer changes in the MPFS this year, there was also the advent of PAMA 2014, which started curbing Medicare payment reduction that was otherwise controlled under SGR provisions in Medicare law.

However, the most noticeable changes that have a strong impact are in the sectors of Radiology and Radio Oncology. Here is a brief round-up of what provisions are in motion and how they impact the said sector.

New Reporting Place of Service Procedure

From 2016, Radiologists working under a hospital owned and controlled centre of radiology, will report professional component claims with a different Place of Service (POS) code. The hospitals, too, will utilize a modifier to report location-based service’s technical components. While the current POS code 23 will remain the same, the POS code 22 will be modified.

Changes in Stereotactic Radiosurgery Valuation

With respect to the differences in stereotactic radiosurgery related to non-robotic and robotic linear accelerator medical care, an identical valuation and coding revision procedure will be incorporated. According to CMS, complete fees would be combined under CPT codes, and the G-codes will be cancelled in 2016.

Modifications in the Surgery Packages

In 2017, the global surgery packages will be unbundled, as the global period of 10 days will be reduced to 0 days. The modifications in the reimbursements will be in agreement with values of services within the global period, with regards to present bundled package.

Surgery Packages

Coding and valuation of mammography

In 2016, CMS might eliminate the variations between film-screen and digital techniques through the removal of digital mammography G-codes. Both the techniques will be reimbursed at same rates within CPT codes. The valuation modification is expected to affect technical aspects of global billing.

New valuation system of Radiation Treatment

CMS has suggested the elimination of treating the vault as a direct cost to bring down the radiation therapy’s total reimbursement by at least 8 percent. Although, there have not been any concrete developments on this yet, further progress will become evident in 2016.

Payment for secondary interpretation

According to CMS, the current practice of non-remuneration for the secondary interpretation of existent images will be refitted to making payments under certain cases. This will aid Medicare in attaining cost-effectiveness through the removal of repetitive studies. CMS also hopes to reduce radiation exposure through this alteration.

Application of Value-Based Payment Modifier (VM)

The Value-Based Payment Modifier (VM) program is advocated along with the accepted Physician Quality Reporting System (PQRS). The VM will apply to more doctors by 2016, and to Medicare specialists in 2017.

Application of Clinical Decision Support

2017 will witness the introduction of a Clinical Decision Support (CDS) mechanism for advanced imaging. As further developments take place in this aspect, all radiologists will have to coach their referring counterparts in the proper documentation of advanced imaging system usage. Any violation will make the radiologist liable for penalization.

Modification in valuation of film and digital systems

A modification is expected about the 2015 MPFS decision to reduce 200 procedure codes by a substantial amount, to eliminate film processing expenses. It was applied without acknowledgement of the expenses involved in acquiring, deciphering and storing graphics through digital systems (PACS).

These regulations come with the probability of affecting physicians and healthcare institutions in a positive, negative or even neutral manner. What could be done here, is to stay up-to-date and flexible regarding further developments.

Reetu

Manager - Sales & Operations at Medphine
Reetu Singh is working as manager at Medphine. She is very specific when it comes to updates and changes in the industry. She keeps an eye on all the major changes that could affect the providers and practices, and also supports them in keeping themselves updated about regulations Medicare, Medicaid and various other commercial insurances, allowing them to practice with freedom.

Reetu

Reetu Singh is working as manager at Medphine. She is very specific when it comes to updates and changes in the industry. She keeps an eye on all the major changes that could affect the providers and practices, and also supports them in keeping themselves updated about regulations Medicare, Medicaid and various other commercial insurances, allowing them to practice with freedom.

Reetu

Manager - Sales & Operations at Medphine
Reetu Singh is working as manager at Medphine. She is very specific when it comes to updates and changes in the industry. She keeps an eye on all the major changes that could affect the providers and practices, and also supports them in keeping themselves updated about regulations Medicare, Medicaid and various other commercial insurances, allowing them to practice with freedom.

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