Lung cancer is one of the most common cancers and the leading cause of cancer-related death in both men and women in the United States. This screening is aimed at the early detection of non-small cell lung cancer. On 10th Feb 2022, the Centers for Medicare & Medicaid Services (CMS) announced a national coverage determination […]
By its very nature, oncology is one of the more stressful fields of medicine. Physicians are involved in scenarios dealing with life-threatening diseases and complex treatments every day. That means any other work apart from patient care will add stress. This includes administration and execution of oncology medical billing. Annual changes in medical coding, payer-specific billing […]
It is important for all oncologists to be prepared as significant changes to the Evaluation and Management (E&M) codes E/M are into effect from January 1, 2021. Components for code selection were narrowed down to make them more clinically intuitive and to reduce variation among contractors and payers. Elements of MDM affecting coding for an […]
The Radiation Oncology (RO) Model goals to improve the quality of care for cancer patients getting radiotherapy (RT) and move toward an easy and predictable payment system. The Radiation Oncology Model tests whether modality agnostic, bundled, site-neutral, prospective, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for […]
Oncology practitioners in CMS’s Oncology care model (OCM) are willing to take on two-sided risk, according to the Community Oncology Alliance (COA) survey. The oncology practitioners are confident they can get success in providing quality and cost-effective cancer care as the healthcare system undergoes the shift from fee-for-service to value-based care. Community Oncology Alliance surveyed […]
In the healthcare industry, Value-based healthcare is the new delivery model in which care providers, including hospitals and physicians, are rewarded for helping patients improve their health and are paid based on patient health outcomes. This model has great adoption in Oncology for delivering holistic patient care while driving sustainable cost savings. In this model participating […]
Billing and Coding Guidelines (continued…) Treatment devices, designs, and construction may be charged during a course of therapy when documentation substantiates multiple volumes of interest/ports, the use of custom-made devices, and/or the necessity of replacement devices. Providers should bill for devices at the beginning of the treatment course and then may bill again later in […]
Major Reasons for Denial Services performed for diagnoses not listed as covered in this policy or for excessive frequency will be denied as not medically necessary. Frequency is considered excessive when services are performed more frequently than generally accepted by peers and the reason for additional services is not justified by documentation. Indications not listed […]
Accurate medical coding plays an essential role in healthcare information management and overall quality of care. Medical coding audits, both internal and external, ensure that healthcare organizations have the proper policies and procedures in place to achieve quality medical coding. Regular audits can reveal inaccuracy issues, such as outdated codes or even fraudulent billing. These […]
Many professionals or experts working in the healthcare IT industry, policy specialists, and new industry stakeholders continue to investigate into the 1,473-page proposed “rule” released by the CMS or Centers for Medicare and Medicaid Services in July 2018 that provides updates on the OPP or Quality Payment Program and Physician Fee Schedule. This new update […]
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