How to prepare: Radiation Oncology Model, Part 1

Check your participation status and build your plan

Are you a hospital outpatient department, physician group practice or freestanding clinic providing radiation therapy services? If so, you may be required to adopt the new mandatory Radiation Oncology Model.

Mandatory participation is randomized by Core-based Statistical Areas. You can check your organization’s participation status online. CMS released the Final Rule for the RO Model, giving providers 60 days to prepare for program launch on January 1, 2022. If your organization performs radiation therapy in a ZIP code on the list, you will need to begin preparing for the model.

Build your team

For effective planning, your practice should first identify a governance team to lead transition planning. This team should be multidisciplinary to assist with the different components of the RO Model. Team members should include:

• Administrative Leaders
• Physician Leaders
• Finance
• Quality
• Information Technology
• Population Health

Learn the rules

It is imperative for your working team to understand the RO Model requirements, including new billing guidelines, quality measures and clinical data reporting requirements. In accordance to the Final Rule, the requirement that RO participants collect and subject quality measures and clinical data elements will be optional in PY1 2022.

Unlike the fee-for-service model, the RO Model is a two-part prospective payment model with new billing codes and modifiers used to indicate the start and end of an approved radiation therapy episode. Included cancer types and modalities of treatment are listed on the CMS website.

RO Model quality measures and clinical data element reporting requirements will require your practice to adapt and work collaboratively to enable practice transformation efforts and ensure accurate documentation and accessible reports.

Your team may need to adjust your practice workflow to ease data abstraction for analysis and reporting.

Leverage expertise

Practices should consider partnering with a third-party resource to understand their data in the context of the RO Model in preparation for implementation. As there are many factors that impact CMS reconciliation, providers should look for partners who specialize in claims data analysis, data analytics and payment monitoring.

DataGen offers payment policy expertise and value-based strategies that help providers effectively navigate healthcare payment changes like the RO Model. Working closely with organizations, DataGen:

• reviews practice claims data to ensure compliance with the model;
• validates that CMS applied the methodology as described in the rules for accurate reconciliation results;
• helps practices understand trends in their data that are influencing their performance; and
• evaluates the impact of future program changes for providers and help them plan and prepare for what’s next.

Stay tuned for more details on How to Prepare: Part 2 – Billing Guidelines.