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A One-Stop-Shop for Medical and Radiation Oncology Billing News

Due to constant advancement of medical technology and healthcare regulations, oncology billing is a dynamic, fast-changing industry. RC Billing wants to keep clients on the leading edge of what's happening, so we maintain this area of the website as a "clearinghouse" for information about oncology news, local coverage determination, CPT codes, IMRT billing and coding and general oncology billing services. Whether it's a legal change that could affect our industry or just an opportunity to pass along the latest news, you'll find it here.

Radiation Oncology News

August 2017 Radiation Oncology News (View More News and Articles)

OMG! Did You Read The CY 2018 OPPS Proposed Rule?

You may be an expert in communicating through text messages, acronyms and emoji's; however, are you an expert in interpretation of the CMS vernacular?  The medical field relies on the understanding of acronyms, abbreviations and even Latin, but oftentimes people forget that CMS communicates with a different language that may be Greek to you and your practice.

Recently, CMS published the CY 2018 OPPS Proposed Rule, which was full of this exclusive language and included terms such as conditional and unconditional packaging.  While review of the proposed fees may indicate a potential reimbursement increase for certain services next year, a closer look may tell a different story.

CMS assigns a Status Indicator (SI) to each HCPCS code defining the status of the code, such as deleted, packaged or separately paid.  One concept communicated through the SI code is the concept of Conditional Packaging, which allows a single code to be paid separately if performed alone or packaged depending on other codes reported.  This type of packaging is defined by SI codes Q1 and Q2.  CMS defines that Q1 indicates a service would be packaged if performed on the same date of service as a code with S, T or V Status Indicator and Q2 applies to packaging with code defined with a SI of T.

Previously, low cost drug administration codes, such as CPT® 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular were excluded from this type of packaging; however,  in the recent proposed rule, CMS has suggested  conditional packaging would apply to certain Level 1 and 2 drug administration services.  If this proposal is finalized, this would result in this code and other administration codes defined with the Q1 Status Indicator to be packaged when billed with other codes defined as S, T or V, resulting in the loss of separate payment.

While the reimbursement for these codes is not a total loss, understanding when and how these codes will be paid is important to understand the financial impact of this proposed change.  Misinterpretation or misunderstanding of the CMS dialect can adversely affect compliance, reimbursement and the ability to forecast revenue for future years.

If you don't have time to learn a new language, let Revenue Cycle Inc.  be your interpreter for this complex language.  RCI offers of a variety of consulting options, including ongoing support through our Client Resource Center.  For information on our services, please contact us at www.revenuecycleinc.com  or 512-583-2000.