What to do to Prepare for RO APM

The Radiation Oncology Alternative Payment Model (RO APM) is currently set to begin January 1, 2022, for physicians, hospitals, and freestanding centers that are located within one of the zip codes chosen by CMS. As it stands, with the exception of some opt-out options, participation is mandatory for practices in the chosen zip codes. Participation is not allowed for practices outside of those zip codes. If your practice was one of the “chosen” ones, here are a few things you can do now to prepare for the January 1st implementation.

1. Check with your EHR vendor to see if it will be ready for the data collection metrics required for RO APM. There are 4 Pay for Performance (P4P) measures and 5 Clinical Data Element (CDE) sites that require data submissions to CMS. Make sure to schedule any necessary upgrades early enough to work out problems before January 1st gets here.

2. Load all necessary HCPCS codes into your EHR and billing systems to report your APM episodes. The codes are available here. Don’t forget to add the start and end of episode modifiers as well.

3. Study the P4P and CDE data requirements. Here is the CMS guide for P4P and CDE reporting. Have providers make changes now to their documentation to get used to capturing all needed data to report these measures.

4. Log in to your practice’s Radiation Oncology Administrative Portal (ROAP) and make sure all functions are working properly. You can pull your practice’s case mix and historical experience spreadsheet here, and use this worksheet to estimate your APM payment rates. The 2022 data will be available sometime in November or December after the final rule is published. This is also the portal for submitting and retrieving data.

5. Pull fee for service Medicare practice data from a prior year (or years) and do a side-by-side comparison of 2022 fee-for-service payments and RO APM bundled payments, and calculate the net expected loss or gain to your practice. Make sure to account for changes in treatment protocols (hypofractionated treatment).

For more information visit https://innovation.cms.gov/innovation-models/radiation-oncology-model and be sure to attend CMS’ upcoming webinars.

Are you attending ASTRO or SROA this year? Be sure to come by the RBS booths to learn more about our company and services. Contact us to learn more about how we can assist your practice.