Following our discussion of the new supervision requirements for therapeutic services in the hospital outpatient setting, we received several questions surrounding the supervision requirements for services delivered in the physician office or freestanding setting. It had always been our understanding that physician offices were subject to stricter requirements, but it's not something that has been excplicitly addressed in the Physician Fee Schedule.
It took some digging, but it seems that the supervision requirements for chemotherapy administration are part of the "incident to" billing rules for physician offices. (See this article for more.) In order to be able to bill for chemotherpy administration in the physician office setting, a physician must provide "direct supervision." Direct supervision means that the physician is physically present in the office suite for the entire duration of the services and immediately available to provide assistance. A complete explanation of the "incident to" rules is available here.
Physician Supervision Requirements in the Freestanding Setting
My colleague Brian Maher from Technology Insights recently wrote the following article on breast imaging technologies that I thought would be of interest:
Each year, after reviewing high-impact publications and findings from major clinical conferences, my research team and I like to reflect on the key imaging technology trends we've seen across the past year, and forecast how many of these trends will impact the provision of imaging services in the future.
One trend which continues to amaze us is the ever-increasing number of modalities which can be deployed at various stages in the breast cancer imaging pathway. From screening to diagnosis, from staging and pre-surgical planning to treatment monitoring, over a dozen different modalities are jockeying for position. Presently, 2D digital mammography, ultrasound, and breast MRI are considered to be "must have" technologies, representing the accepted clinical standards for various indications. However, while each of these modalities has a distinct and validated role in the care pathway, they also have their respective shortcomings, which are clinical and/or operational in nature.
The Next-Generation of Breast Imaging Technologies
All of you are familiar with the work that Lance Armstrong's Foundation LiveStrong has been doing to promote survivorship care. Recently, the foundation has turned its attention to patient navigation and providing support services to patients and families. While the program is still in development, the goal is to roll out a nation-wide service that helps patients to find "the right resources at the right time."
According to our contact at LiveStrong, the initiative came about organically. People who were familiar with LiveStrong would call the foundation looking for advice and support, and the Foundation staff would try to respond as best they could. Given the demand, the foundation has been working across the past year to develop more formalized resources and services.
Patient Navigation Services Available through LiveStrong