A variety of federal legislative activities during 2014 and 2015 contained rulings that will begin to affect Medicare reimbursement to physicians next year. Most recently, The Centers for Medicare and Medicaid Services (CMS) issued its Medicare Physician Fee Schedule (MPFS) Final Rule for 2016 that will govern its payments to physicians. The overall impact of the final MPFS changes to radiology and radiation oncology practices compared with the proposed changes issued earlier this year, is estimated by CMS as follows:
Categories:
radiology reimbursement,
radiation oncology reimbursement,
MPFS,
value modifier,
PQRS,
MIPS,
MACRA
There are relatively few CPT1 coding changes for radiation oncology treatments in store for 2016, at least when compared with diagnostic and interventional radiology. CMS, the Centers for Medicare and Medicaid Services, is still considering and revising a new set of codes for radiation treatment delivery that was proposed in 2015 but not yet implemented. When implementation does occur, these codes will most likely not involve valuation differences, although this in an uncertainty until CMS takes action in some future year.
Categories:
radiation oncology reimbursement,
radiation oncology coding,
brachytherapy
The landscape of Medicare payment policy will be changing over the coming years as a result of actions taken in 2014 through the Medicare Physician Fee Schedule (MPFS) and the Protecting Access to Medicare Act (PAMA). The MPFS for 2015 contained fewer changes to current payment policy than it did proposals deferred for future consideration. The Protecting Access to Medicare Act of 2014 (PAMA) was initiated to avoid the significant Medicare payment reduction imposed by the Sustainable Growth Rate (SGR) provision in the Medicare law, but it also contained other provisions affecting payment under the Medicare program.
Categories:
radiology reimbursement,
radiation oncology reimbursement,
MPFS,
PAMA
The stage is set for an interesting year of coding, billing and reimbursement in radiation oncology. The CPT1 coding structure for radiation oncology services underwent significant revision in order to bundle certain services that are usually reported together and to clarify the meaning of some codes in the context of current clinical practice. In some cases this required the creation of new CPT codes to describe these services, or revision of the descriptions of existing codes in other cases. Medicare’s decision not to fully recognize these coding changes creates the potential for two different systems to be in place for 2015, and is sure to cause discrepancies between billing for Medicare and billing for other payers.
Categories:
radiation oncology reimbursement,
medicare reimbursement,
radiation oncology coding
The Medicare Physician Fee Schedule (MPFS) contains lower reimbursement in 2014 for diagnostic imaging and interventional radiology due to revisions adopted by the Centers for Medicare and Medicaid Services (CMS) in the annual Medicare rules update published in December. Radiation oncology practices will see a slight increase in the fee schedule while freestanding radiation therapy centers are facing considerable reductions. Meanwhile, Congress took some action to defer even larger cuts but continues to leave the medical community uncertain of future payment rates for physician services.
Categories:
radiology reimbursement,
radiology billing,
medicare,
radiation oncology reimbursement
Even though Congress has averted the across-the-board SGR fee schedule cut (26.5%) for another year, radiologists will take another 3% cut this year. This, in addition to expanding the PC MPPR of 25% for CT, MRI and ultrasound imaging to include other members of the group practice, means that there is no good news for radiologists this year.
Categories:
radiology reimbursement,
regulatory,
medicare,
radiation oncology reimbursement
