Cancer CarePoint Blog

Radiation Oncology Reimbursement is in Jeopardy!

On July 1, CMS announced significant proposed changes in radiation oncology reimbursement. If approved, the American Society for Radiation Oncology has predicted a reduction of about 20 percent for radiation oncologists in 2010. Some of the major changes in the 2010 proposed Physicians’ Fee Schedule include:

-A reduction of the conversion factor of 21.5 percent (from $36.066 to $28.3208)
-A reduction in the practice expense and malpractice values
-A modification in the equipment utilization rate (for equipment over $1 million) from 50 percent to 90 percent; which will cut the technical component for IMRT services by as much as 40 percent

This could mean a melt-down for physician-based reimbursement. Meanwhile, hospital-based reimbursement for outpatient radiation therapy is expected to increase.

Now more than ever, physicians and hospitals must work with one another to determine the optimal organizational and billing structure -- ensuring your radiation oncology program’s long term financial viability. We’re here to help. Cancer CarePoint can assist with the financial modeling of your radiation center as well as determine the most optimal billing and organizational structure for your group before these changes dramatically impact you!

To discuss how Cancer CarePoint can assist with financial modeling for your practice, please call us at 1.800.998.5859. To best strategically position yourself for the future, the financial health of your practice is critically important.

We not only offer financial and organizational modeling, but we can also assist your radiation therapy practice with:

-Global Billing Assessments
-Freestanding vs Hospital-Based Billing Comparisons
-Oncology Coding, Reimbursement and Billing Assessment
-A Fiscal QuickStat of your practice
-Revenue Cycle Analyses

Visit Our Website For More Information: Click Here

Medical Oncology Payment Reductions?

There are two striking pieces of reimbursement reform that should be seriously considered in the context of impact to your personal medical oncology practice, including:

1. National Healthcare Reform:  In mid-June, President Obama called for an additional $313 billion in Medicare and Medicaid cuts.  The magnitude of these reductions includes substantial reimbursement declines for medical oncology practices as well as imaging services.  All in all, reductions of more than $600 billion in CMS plans is contemplated for a healthcare proposal that will likely reach cost of $1 trillion.  Inherent in this plan is a “public” insurance plan that seeks to competitively lower prices of private insurers.  As such, it is envisioned the “public” plan would reduce payments to Medicare rates or Medicare plus 10% with private plans following suit.

2. Proposed Rule CMS 2010 Medicare Physician Fee Schedule:  As currently proposed, CMS would reduce Medicare payments to oncologists by 6% overall.  In addition, a 21.5% reduction is contemplated in Medicare payments for physician-related services, including chemotherapy administration.  To further minimize oncology physician care, CMS is proposing to eliminate consultation codes and further decrease payments for equivalent new patient visits.  And, in a broader sense, CMS proposes bonuses to primary care as a result of declining payments to specialists as well as eliminating the geographic differences in payments nationwide.

Can Your Practice Handle These Dramatic Changes?

Certainly there is much more fine tuning underway to finalize both initiatives; however, estimates of medical oncology payment reductions are upwards of 25% and this may represent a conservative view.  We encourage all medical oncology practices, at a minimum, to model their practices at Medicare rates to assimilate what the future practice may generate financially in light of these significant reductions in payment.  If national healthcare forces private payers to Medicare rates, it is likely many community oncology practices could not survive.  To discuss how Cancer CarePoint can assist with financial modeling for your practice, please call us at 1.800.998.5859 or visit our Practice Enhancement Service web page.To best strategically position yourself for the future, the financial health of your practice is critically important.

Cancer CarePoint Can Not Only Assist You With Practice Modeling, but also:

-Oncology Coding, Reimbursement and Billing Assessment
-A Fiscal QuickStat of your practice
-Revenue Cycle Analyses

Visit Our Website For More Information: Click Here