Oncology & Hematology Coding Alert

Oncology practices escape an impact in 2017.

You have been busy adapting to and implementing the 2017 changes applicable for oncology practices. Are you worried how the Medicare Physician Fee Schedule (MPFS) impacts your practice? Here is relief for oncology practices.

The Centers for Medicare & Medicaid Services (CMS) for CY2017 MPFS final rule was released in November of last year. Here is a reassurance for all oncology and radiation oncology practices. The final rule does not impact oncology and radiation oncology practices.

CMS rule: You can access the CMS rule and RVUs for each code on: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-F.html.

Conversion factor for 2017: The conversion factor for 2017 is $35.89. The conversion factor in effect in CY2016 was 35.8043. To this an update factor of 0.50 percent (1.0050), CY2017 RVU budget neutrality adjustment of -0.013 percent (0.9987), CY2017 target recapture amount of -0.18 percent (0.9982), and CY2017 imaging MPPR adjustment of -0.07 percent (0.9993) was applied to yield a CY2017 conversion factor of 35.8887.

How it impacts oncology practices? According to the MPFS final rule summary for 2017, specialties for oncology and radiation oncology have not been impacted. “Despite the coding and reimbursement changes impacting oncology in 2017, the effect on reimbursement for the specialty seems to be budget neutral overall,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services, LLC (“PERCS”), a division of Pinnacle Healthcare Consulting.

Table 1 shows the allowed charges and impact on hematology/oncology and radiation oncology practices.