October 31, 2013
CMS To Release 2014 Payment Rules By Late November
The Centers for Medicare and Medicaid Services (CMS) announced a delay in publishing 2014 Medicare final rules due to the government shutdown. The final hospital outpatient prospective payment system and ambulatory surgical center payment system rules are affected, as well as revisions to the physician fee schedule.
"Although we are still assessing the impact of the partial government shutdown on completion of the calendar year 2014 Medicare fee for service payment regulations, we intend to issue the final rules on or before November 27, 2013 to be effective on January 1, 2014," the agency posted on its website.
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New and Revised Radiation Oncology Coding for 2014
The American Medical Association recently published the list of new, revised and deleted procedure codes effective January 1, 2014. There is one new add-on code that applies to radiation oncology.
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Lawmakers Tell CMS To Drop Proposed Pay Cuts To Community Cancer Centers
A bipartisan group of 114 House lawmakers recently told the Centers for Medicare and Medicaid Services (CMS) to drop its proposal to pay the same rates for cancer care in physicians offices and hospital outpatient departments. CMS is proposing to cap payment to community cancer centers at 2013 hospital payment levels for therapeutic radiation oncology and diagnostic imaging beginning January 1, 2014.
CMS touts the proposal as pay parity, but the lawmakers, using an industry argument, say the proposal would increase disparity in pay. According to a letter to CMS, "Community cancer clinics would be paid 35% less than hospital rates for a representative mix of radiation therapy services."
Senator John Cornyn (R-TX) is circulating a similar letter among Senate Finance Committee members.
Community cancer centers are struggling to stay open, the lawmakers write, because Medicare doesn’t pay well enough. In the six years that the Community Oncology Alliance has been tracking the industry, 288 facilities closed and 469 practices merged with hospitals. Eight years ago, 87 percent of cancer care was provided at clinics, and by 2011 clinics accounted for just 67 percent of that care. The shift to hospitals sped the following two years.
The AAPM opposed the CMS proposal in written comments to the Agency in August stating that, "The proposed policy change is particularly damaging to CPT codes which have high direct practice costs."
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