Regina Lohr, Oncology Roundtable
In follow-up to our recent 2013 Oncology Medicare Reimbursement Update, members asked for more specifics on the new Transitional Care Management (TCM) CPT codes included in the 2013 Medicare Physician Fee Schedule.
Requirements, reimbursement vary by patient complexity
The two codes allow providers to bill for one face-to-face visit as well as non-face-to-face services provided to manage patients’ transitions from an inpatient care setting to the community setting (such as the patient’s home or assisted living). Providers billing under these codes must communicate with the patient or caregiver shortly after discharge and meet with the patient within one or two weeks, depending on the complexity of the patient’s case.
What cancer providers need to know about using the new CPT codes
CMS will implement its proposed cuts – with some modifications - to payment for IMRT and SBRT treatment delivery in the freestanding setting.
Last night, CMS issued the final 2013 Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS). The Oncology Roundtable team is currently combing through the regulations, and we will be publishing our analysis over the next several weeks.
CMS Issues Final 2013 HOPPS and MPFS
Anne Taylor, Oncology Roundtable
Last week, in the FY 2013 Inpatient Prospective Payment System (IPPS) Proposed Rule, CMS announced five proposed measures for the PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program.
In the development of the PCHQR, an extension of the National Quality Strategy mandated by the ACA, CMS employed similar policies as those outlined in the Hospital Inpatient Quality Reporting (IQR) Program to guide metric selection and development, as well as procedures for hospital participation.
CMS considered input from the PPS-exempt cancer hospital (PCH) Technical Expert Panel, consumers, advocacy groups, and providers in the development of these measures.
The selected PCHQR Program measures include two CDC National Health Safety Network (NHSN) health care associated infection (HAI) outcome measures, one process of care measure for colon cancer, and two process of care measures for different types of breast cancer. Each is an NQf-endorsed measure.
CMS proposes five quality measures for PPS-exempt Cancer Hospital Quality Reporting Program