By: Tammy McCausland
Teri Bedard, Executive Director, Client & Corporate Resources with Revenue Cycle Coding Strategies, discusses the impact of COVID-19, telehealth, and hypofractionation. This content originally appeared in Radiation Oncology News for Administrators, Vol. 31 No. 3.
A: One of the bigger changes has been telehealth. It existed before COVID-19, but it was underused, or limited in how it could be used, and now there’s been a lot of push to increase its use. There’s a lot of congressional action. There have been more requests for telehealth to continue and maybe be expanded, so one of the big concerns is reimbursement. Right now, during COVID-19, if you do a telehealth visit or an in-person visit, you get paid the same amount. Telehealth typically got paid a lot less before COVID-19, so now there’s the concern whether telehealth will continue to be paid as it is now. They say, “We have to maintain our Wi-Fi. We have to maintain the technology, and the time with the patient.” How do you value that going forward?
There were changes with supervision for some of the different services. I think some of that will roll back to what it was. It will be interesting to see if the public health emergency will extend for the full year. There’s going to be some loosening of rules or regulations, but also, there’s a concern of fraud and inappropriate use of some of the waivers that have been part of COVID-19. I think there will be opportunities to look at our processes, what did we do well during COVID-19 that should be processes we want to keep, and what didn’t work as well as we hoped.
A: Yes, they bill the same code. They just have to use a modifier (95) if they want to identify that the visit was a telehealth visit. They still bill their place of service as if it were a person, so if they were going to be doing this visit in person, what would that place of service be on a claim form? That’s what they’re going to report, so that’s how they get paid the same.
A: It really is a trend, and I think that’s where stereotactic is. We’ve had it for some time, but it’s becoming much more of an option because patients don’t want the long courses. Patients want to have time to spend with their family and friends, doing things that they like and not be coming in to the clinic five days a week for three to eight weeks. Also, the codes tend to be paid a little bit higher, especially when it comes to the stereotactic.
The thought is that you can treat more patients because you do them in shorter courses. The concern from physicians is, “If I already have open slots on my calendar, do shorter courses mean I have less patients coming in day-to-day because they only are here for five fractions or 12 fractions instead of scheduling someone for 30 to 45 appointments. How do I fill my calendar?” By having the shorter fractionation, there is less burden in some ways, but from a financial standpoint you’re billing less, and that’s where the concern from reimbursement comes from.
A: I would think so. I think even for looking at the RO–APM Model itself because if you’re given one amount of money based on a diagnosis, this is all you’re going to get. It doesn’t matter what you do. The incentive would be to do a shorter course, a hypofractionated course, because there are fewer resources needed, and you’re going to get this money whether you treated patients with five fractions or 45 fractions, so there’s a push for that, as well.
It’s also relevant to the referral patterns that your physicians have. Can you fill the slots on your schedules with those patients? There’s also additional quality assurance that has to happen if they’re doing a lot more stereotactic. That’s a burden sometimes, and if there’s extra dosimetry staff, administrators need to look at what that means to the process overall.
A: Possibly because with physics they have to do QA anyway, but with stereotactic, there’s very specific QA required. There’s also very specific QA required with IMRT. With 3D we may do some of it, but we don’t do it with each plan that we do, whereas we do it normally with IMRT and stereotactic treatment that has to be documented. That can mean some additional work that goes onto physics, in addition to everything else that they may be doing.
With brachytherapy there’s a lot of work by physics that they don’t get to bill for. That’s just part of the physicist’s role in the brachytherapy with the sources and things like that. Some of the billing codes for revenue, when it comes to stereotactic, are your highest-paid codes when it comes to treatment delivery, but for five fractions, that doesn’t always necessarily make up the difference for what it may have been for a fraction course of 25, 30 and beyond.
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