2016 Billing and Coding Update for Radiation & …

1 2016 Billing and Coding Update for Radiation & Medical OncologyJanuary 29, 2016 ACEC opyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at InformationRevenue Cycle W. Braker LaneBldg. F, Suite 200 Austin, Texas (512) 583-2000 Copyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Eggleston, MBA, BSRT(T)VP Revenue Cycle 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at presentation was prepared as a tool to assistattendees in learning about documentation, chargecapture and Billing processes.

2 It is not intended to affect clinical treatment patterns. While reasonableeffortshave been made to assure the accuracy of the information within these pages, the responsibilityfor correct documentation and correct submission ofclaims and response to remittance advice lies withthe provider of the services. The materialprovided is for informational purposes have been made to ensure the informationwithin this document was accurate on the date ofpresentation. Reimbursement policies vary from insurer to insurer and the policies of the same payormay vary within different regions. All policies should be verified to ensure codes, descriptions and other data are copyright 2016 American Medical Association (or suchother date of publication of CPT ).

3 All Rights Reserved. CPT is a registered trademark of theAmerican Medical Association. Code descriptionsand Billing scenarios are references from the AMA,CMS local and national coverage determinations(LCD/NCD), the ASTRO/ACR Guide to RadiationOncology Coding , the ACRO Practice Management Guide and common practice standards 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Review of HOPPS and MPFSB asic Review of HOPPS and MPFS Final Rule Items Final Payment RatesMPFSMPFS Final Rule Items Final Payment RatesHOPPSHOPPS New Brachytherapy Codes Provider Based Department Changes Codes 77295 and 77300 in 2016 Coding Changes Impacting CY 2016 Coding Changes Impacting CY 2016Q&AQ&ACopyright 2016 RCI All Rights Reserved.

4 Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at and MPFS Payment SystemsHOPPS Payments based on costs Adjusted by a wage index Grouped into APC s Example : Tx Devices 77332, 77333 and 77334 Historically the same payment rate under HOPPS Changed for 2016 MPFS Codes have RVUs CF is applied to all RVUs GPCI s Codes can be split into Global, TC, 26 payment Example: Tx Devices 77332, 77333, 77334 Historically different payment rates under MPFSC opyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at ScenariosHospital OutpatientTechnical ServicesUB04 Physician Services (-26)CMS 1500 Freestanding FacilityGlobal BillingPro & Tech Services CMS1500 Split BillingPhysician Services (-26) CMS 1500 Technical Services (TC) CMS 1500 Copyright 2016 RCI All Rights Reserved.

5 Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Updates to RulesHospital Outpatient: Hospital Billing Technical ChargesHospital Outpatient: Hospital Billing Technical ChargesPhysician/Facility: Physician Practicing in a Hospital Setting & Freestanding FacilitiesPhysician/Facility: Physician Practicing in a Hospital Setting & Freestanding Stay up to date Stay informed Get involvedCopyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at vs. FinalProposedCMS s plan, intent, thoughts for rules, regulations and reimbursement for upcoming yearFinalDetermined after consideration and debate occurs based on comments receivedProposed RulesConsideration of CommentsFinal RuleCopyright 2016 RCI All Rights Reserved.

6 Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at PHYSICIAN FEE SCHEDULE (MPFS) 2016 Final RuleCopyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Factor (CF) Update The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) put into law April 16, 2015 Repealed sustainable growth rate (SGR) Revised and established PFS updates for several years Established a Merit-based Incentive Payment System (MIPS) CY 2016 CF proposed to be $ & finalized at $ increase over CY 2015 CF of $ , Decrease of Budget Neutrality Factor Decrease of Target Recapture Amount BUT WAIT!

7 CMS published MPFS correction notice on 1/5/16 new conversion factor 2016 CF = $ 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Conversion Factor Budget Neutrality keeps CMS budget in expected range, factor subtracted from CF of 2015 + the Update factor Target Recapture Amount Factor applied if due to misvalued codes in previous years, expenditure reduction does not meet the 1% target Pathology had high number of misvalued codes that are now impacting reimbursement for all specialties in 2016 Copyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at 2016 Conversion Factor = $ !

8 MPFS EquationWork RVU * Work GPCIPE RVU * PE GPCIMP RVU * MP GPCIC onversion Factor++*Physician work provided per servicePractice expense, overhead etc. for serviceMalpractice is professional liability insuranceUsed to convert RVUs into $$$GPCI = Geographic Practice Cost Index (adjusts each different type of RVU) for a particular locality in the countryCopyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Payment Impact TableTABLE 62: CY 2016 PFS Estimated Impact on Total Allowed Charges by Specialty*(A)Specialty(B) AllowedCharges (mil)(C)Impactof WorkRVUC hanges(D)Impactof PERVUC hanges(E)Impactof MPRVUC hanges(F)CombinedImpact** Radiation Oncology$1,7760%-2%0%-2% Radiation Therapy Centers$520%-2%0%-1%** Column F may not equal the sum of columns C, D, and E due to conversion to AMA CPT codes was not finalized, G-codes continued, this will decrease the overall negative impact from what was 2016 RCI All Rights Reserved.

9 Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at RVU Changes SnapshotCopyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at DescriptionTOTAL NON-FACILITY RVUsHCPCSDESCRIPTION2015 RVU Totals2016 RVU TotalsDiff77263 Radiation therapy 77280 Set Radiation therapy 77285 Set Radiation therapy 77290 Set Radiation therapy 772953-d radiotherapy 77300 Radiation therapy dose 77301 Radiotherapy dose plan 77306 Telethx isodose plan 77307 Telethx isodose plan 77316 Brachytx isodose plan 77317 Brachytx isodose 77318 Brachytx isodose 77321 Special teletx port 77331 Special Radiation 77332 Radiation treatment aid(s) 77334 Radiation treatment aid(s)

10 77338 Design mlc device for 77427 Radiation tx management 77431 Radiation therapy 77432 Stereotactic Radiation 77435 Sbrt 77470 Special Radiation 77778 Apply interstit radiat ( )G6002 Stereoscopic x-ray G6012 Radiation treatment G6013 Radiation treatment G6015 Radiation tx delivery ( )G6016 Delivery comp ( )2015 - 2016 MPFS Global CompareCopyright 2016 RCI All Rights Reserved. Do Not Duplicate. Work product, information & guidance provided by RCI are subject to the terms & limitations provided at Final Rule MPFS Global Non-Facility Course CompareType2015 Global - CF = $ Global - CF = $ - 2016 VarianceGlobalGLOBAL % Change2D 10 fxs$4, $5, $ w/IGRT 35 fxs$16, $18, $1, 42 fxs$25, $23, $2, - Linac$5, $4, $ Linac 5 Fxs$10, $10, $ - HDR$5, $5, $ - LDR$3, $3, $ T&O - HDR$5, $5, $ Cyl 1 Chan HDR$4, $5, $ Multi Chan HDR$6, $6, $ Misvalued Codes High expenditure screening tool identified codes which may be potentially misvalued.