The promptness of your billing, account follow-ups, and reimbursements have a significant impact on your oncology practice’s financial performance. Being in compliance with all cancer billing regulations is essential to ensuring your facility’s profitability. However, given how frequently oncology medical billing regulations change, it might not always be simple to remain compliant.
Let’s glance through several Oncology Medical Billing changes that took place in the year of 2023
1. Payments for radiation oncology and hematology/oncology are being reduced
Due to changes in RVU, payments to doctors who specialize in radiation oncology and hematology/oncology are anticipated to fall by 1% in 2023. The impact on hematology/oncology can be attributed to changes in practice expense (PE) RVUs, whereas the impact on radiation oncology can be ascribed to changes in work RVUs. The simultaneous termination of the interim 3% payment rise that physicians received in 2022 to assist lessen the effects of the epidemic may have an even greater effect on oncologists.
2. CMS finalized new MIPS quality measures for cancer
For the CY 2023 performance period/2025 MIPS payment year, the CMS included new cancer-related MIPS quality metrics. One of the new measures tracks the number of patients with colorectal, endometrial, gastroesophageal, and small bowel carcinoma who have undergone testing for mismatch repair or microsatellite instability. Another measure keeps track of whether patients taking checkpoint inhibitors have been given medication for colitis or diarrhea.
The agency also increased the number of measures for the Oncology/Hematology Specialty Set and the Radiation Oncology Specialty Set, including adult immunization status, use of high-risk medications in older adults, CAHPS for MIPS clinician/group survey, and screening for depression and follow-up plans.
3. The 340B payment rate is rising to ASP +6% per 2023 OPPS/ASC
Despite CMS’s initial proposal to keep the 340B-acquired medicine payment rate at ASP -22.5% for CY 2023, the agency increased the rate to ASP +6% in the final rule. This announcement follows the Supreme Court’s recent ruling to reject the CMS-implemented 340B payment cut to ASP-22.5% in American Hospital Association v. Becerra. The Supreme Court ruled that because CMS did not poll hospitals to ascertain their typical medication acquisition prices, the payment cut was unlawful.
For hospitals taking part in the 340B program, this means an increase in revenue from cancer and other medicine reimbursement of around $2 billion. CMS had to lower the payment rates for non-drug services by 3.09%, which will have an impact on both 340B and non-340B hospitals, in order to maintain budget neutrality.
4. The ASC Covered Procedures List is being updated to include lymph node biopsy or excision and modified radical mastectomy (CPL)
Through its examination of the procedures, discussions with interested parties, and consultations with clinical advisers, CMS came to the conclusion that axillary lymph nodes and biopsy or excision of the lymph node(s) can both be safely carried out in the ASC setting.
After receiving feedback from commentators, CMS changed its initial proposal to include only lymph node biopsy or excision on the CPL and added modified radical mastectomy in the final regulation. These treatments can be performed in an ASC setting thanks to the addition to the CPL, but they are not required to.
5. The reporting period for the new Breast Cancer Screening Recall Rates OQR measure (OP-39) begins in CY 2023.
The Hospital Outpatient Quality Reporting (OQR) Program’s new Breast Cancer Screening Recall Rates OQR measure (OP-39), which was finalized last year, will begin to collect data in CY 2023 for a three-year reporting period.
Since this is a claims-based metric, providers are not required to submit any specific information. The percentage of screening mammography and digital breast tomosynthesis (DBT) studies that are followed by a diagnostic mammography, diagnostic DBT, breast ultrasound, or breast MRI study conducted in an outpatient or office setting on the same day or within 45 days is what is used to calculate it at the facility level.
6. CMS is introducing a brand-new MIPS Value Pathway (MVP) for oncology dubbed Advancing Cancer Care
The optional Advancing Cancer Care MVP is designed for oncology and hematology practitioners and focuses on providing core cancer care management and treatment. It includes two Qualified Clinical Data Registry indicators that are focused on patient experience, end-of-life care, and appropriate diagnosis and treatment, along with ten cancer-specific quality measures. A Total Per Capita Cost metric and 13 improvement initiatives are also included.
The standards of CMS’s new Enhancing Oncology Model (EOM), including as guideline-concordant therapy, 24/7 availability to doctors, and advanced care planning, overlap some with the improvement initiatives of the Advancing Cancer Care MVP. Since we are aware that the EOM quality measures will concentrate on patient experience, end-of-life care management, and other related areas, it is also possible that there will be overlap between the quality measures for the two programs.
Final Reflections
It is assumed that billing is effectively handled internally in oncology. However, the truth is that many oncology practices are unable to simultaneously provide high-quality care and manage the intricate and time-consuming billing procedure. Your Medical practice would be better off outsourcing this specific task. By Outsourcing Oncology Medical billing and coding, your clinic may free up time from non-essential tasks and devote it to keeping up with the rules and requirements for cancer billing, which are constantly changing. Even better, you can increase your bottom line by maintaining strict follow-ups on claims.
