The 2015 coding changes have created havoc for the reimbursement cycle of many radiation oncology practices. What is your billing team doing to manage the fallout?
When CMS issued the Final Rule in November, Medicare only enforced the anticipated coding changes on the Outpatient Prospective Payment System (OPPS). Hospitals were able to transition to the updated technical codes immediately, largely without issue. However, CMS did not enforce the anticipated changes to the physician professional codes. Because the 2014 codes had already been deleted, they issued new, temporary codes for multiple radiation therapies.
Because hospitals no longer report IGRT treatments, some physicians find themselves unable to capture imaging charges performed at the hospital in order to bill for their professional fees. RBS has stepped in for our clients to work closely with the hospital staff to ensure all imaging charges are captured.
Commercial payers have further confused the situation. Some payers are using the old codes to assign authorizations; some are using the replacement codes. Our team has proactively contacted each payer for our clients to determine which codes they are using to assign authorizations, in some cases actively resolving denials before most systems have updated - thereby avoiding payment delays.
In other cases, payers have adapted and are using the G codes, but have decided to use the opportunity to assign new, seemingly arbitrary reimbursement values. RBS is actively managing this situation for our clients and taking the time to educate the payers on the fact that these are replacement codes - not an opportunity to renegotiate fee schedules! We are aggressively appealing reduced payments for the 2015 codes and urging payers to release held payments as quickly as possible.
January is almost always an interesting month in our world. Patient responsibility becomes an issue as deductibles start over for the new year. Medicare, as in years past, instituted a 14-day hold on claims in order to reset their systems. And as always, the Sustainable Growth Rate (SGR) uncertainty hangs over us, with the conversion rate decision pushed back this year until April. The RBS team has been diligently following the updates and doggedly working through each of these scenarios. We’ve made literally hundreds of phone calls to payers and clearinghouses on behalf of our clients. Because we bill as services are incurred, we are able to use real-time information to stay on top of the situation and educate the payers as soon as the issues occur.
As owners and operators of our own freestanding cancer centers, we share the same issues in our own markets and we apply the same tenacious, proactive approach for each of our clients that we do for our own centers.
Is your billing team struggling with any of these issues? We can help. To learn more, contact us at 615.746.4711, or email us at firstname.lastname@example.org.