Commonly asked questions about the Medicare Radiation Oncology Model billing guidelines What are the billing guidelines for the Radiation Oncology Model? RO Model participants must submit claims under the existing Medicare claims system according to the RO Model billing instructions described in the CMS final rule . In addition, RO participants must submit “no-pay” claims for all radiation therapy services furnished in the episode. What are the approved cancer types? The RO Model covers 15 cancer types. These cancer types are commonly treated with radiation therapy under nationally recognized, evidence-based guidelines and are associated with ICD-10 codes that have demonstrated pricing stability. What are the approved modalities of treatment? Modalities covered under the RO Model include three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery, stereotactic body radiotherapy, proton beam therapy and image-guided radiation ...

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.

The new Radiation Oncology alternative payment model will start Jan. 1, 2022, after the proposal is finalized in the calendar year 2022 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, scheduled for early November. This rule will require prospective hospital outpatient departments, physician practices and freestanding clinics providing radiation therapy services to adopt a prospective bundled payment model with new clinical and quality measure reporting requirements. The model is mandatory for participants selected by CMS. The new RO model includes several notable changes that must be addressed for successful participation: Disease sites update The criteria for cancer types have been clarified. Cancer types must be: commonly treated with radiation therapy according to nationally recognized evidence-based guidelines; associated with ICD-10 codes that demonstrate pricing stability; and not determined to be unsuitable for inclusion by the H...

Alternative payment programs are critical to payment and care delivery transformation. CMS is introducing new alternative payment models that provide opportunities to deliver better value of care and support healthcare innovation in the years to come. Rising healthcare trends should be taken into consideration when evaluating new APMs. Yet, keeping ahead of which programs offer you the greatest opportunity can be a major challenge. DataGen put together Navigating Alternative Payment Models: A User's Guide , offering insights on the participation categories—and detail on programs within each category—this resource can help you determine the best course for your organization’s future. Download our user's guide to learn about new APMs, implications for providers and data-driven strategies for successful pro gram execution.

It’s been a year: a year since the first lockdowns and a year since the landscape of healthcare in the U.S. changed forever. While we’re still evaluating the impacts of the pandemic on healthcare policy, we now have seen enough data to assess the effect of the past year on alternative payments models and how participants are reacting. It’s been reassuring to see the strength of APMs has broadly held steady, as has the resolve of the participants in those programs, despite the impact of the COVID-19 pandemic. Here’s what we’ve learned this year, along with what (we think) those lessons can teach us about the future. COVID-19 has not stopped the progress of APMs — but it is delaying it. COVID-19 has extended the period of some programs, like the Comprehensive Care for Joint Replacement and Oncology Care Model, and delayed the start of others, like Kidney Care First and the Radiation Oncology Model. This is, in part, a function of an overwhelmed system. As policymakers and healthcare org...

Background:  After months of anticipation, CMS is planning to go forward with the mandatory Radiation Oncology Model. This bundled payment model, which was first announced in a proposed rule on July 10, 2019, with an anticipated start in January or April 2020, is notable for being one of the first mandatory models the industry has seen from CMS in years. While the model has been delayed, in part due to the complications presented by the COVID-19 public health emergency, CMS finally broke its silence on the future of the model in September with the publication of the RO model final rule. A revised start date was announced in the OPPS final rule in December: the RO model is anticipated to begin on July 1, 2021 and will run through 2025. Key facts: RO participants include freestanding radiation therapy centers, hospital outpatient departments and physician group practices with radiation oncologists that furnish radiation therapy services. The model is mandatory for selected participan...