Oncology Billing Changes In 2023

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Oncology Billing
Changes In 2023
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Oncology Billing Changes In 2023
The promptness of your billing, account
follow-ups, and reimbursements have a significant
impact on your oncology practices financial
performance. Being in compliance with all cancer
billing regulations is essential to ensuring your
facilitys profitability. However, given how
frequently oncology medical billing regulations
change, it might not always be simple to remain
compliant. Lets 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.
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Oncology Billing Changes In 2023
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 CMSs
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
Courts 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.
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Oncology Billing Changes In 2023
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)
Programs 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.
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Oncology Billing Changes In 2023
The standards of CMSs 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.
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