With the advancing Advance Payment Model (APM) becoming a reality in 2022, many radiation oncology centers are seeing a shuffle of resources trying to get ready for the inevitable. The APM is designed to increase the quality of patient care by rewarding high-value patient care...

Radiation oncology departments depend on accurate coding of claims to be reimbursed for their services. Inaccurate coding means no payment and possibly compliance issues that could raise a red flag. Almost all hospitals have a coding department, but that is not always the best solution...

CMS requires that the physician documentation supports their charges. In an audit situation, the only guarantee that you have performed a charge (and received payment) is your written documentation. In today’s world of changing reimbursement (i.e., CMS Advanced Payment Model), coding has become (will be...

Most hospitals have medical coders on staff. Large hospitals that operate 24/7 have more options available to them, whether a dedicated group of medical coders or hiring a third-party medical coding company to help alleviate some of the stress of the large volume of patient...

Sometimes during treatment, a new tumor site is identified that needs treatment. These cases present their own unique set of challenges in the coding and reimbursement areas. Listed below are some items to consider when coding and documenting an additional site of treatment. 1. Watch for...

*The following information is intended for those using ICD-10 Coding prophylactic cranial irradiation (PCI) cases can sometimes be challenging. PCI is often done following a course of radiation to the lung for patients with small-cell lung cancer who do not have evidence of brain metastasis. Here...

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...

Simulations are an integral part of the radiation process. Simulation documentation is relatively straightforward, but there are some pitfalls that we commonly see. Here are a few key items to remember when documenting simulations. Don’t forget the simulation order. Even though it does not represent...

On Monday of this week, CMS released the HOPPS & RO Model Proposed Rule for 2022.  Our team has created the attached summary for your review and the HOPPS payment rate comparison.   CMS did make several updates to the RO Model that everyone in radiation oncology...