Access, Payment & Reimbursement Reform

CMS Releases Final Rule to the Radiation Oncology Model

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems final rule (CMS-1753-F). This announcement includes the finalized modifications to the Radiation Oncology (RO) Model.

The RO Model is set to begin January 1, 2022, and end December 31, 2026. The proposed rule includes the summarized modifications below:

• Adjustment to the pricing methodology (updated baseline period is 2017 to 2019 and lowered discounts to 3.5 and 4.5) for the professional component and technical component, respectively
• Removal of brachytherapy from included modalities
• Removal of liver cancer from included cancer types
• Finalization of cases in which a beneficiary switches from traditional fee-for-service (FFS) to Medicare Advantage during an episode and before treatment is complete. CMS will consider this an incomplete episode and radiation therapy services will be paid under FFS.
• Modification to the current Pennsylvania Rural Health Model (PARHM) overlap policy to only exclude hospitals participating in the model, no just PARHM-eligible hospitals
• Addition of an overlap policy for the Community Track of the CHART Model
• Addition of an extreme and uncontrollable circumstances policy.

For additional information on the RO Model and CMS' final rules, visit the RO Model website or read more on thefinal rule. For questions on the model or for participants needing their model ID, contact RadiationTherapy@cms.hhs.gov.

Posted 11/3/2021

CMS Announces RO Model Updates

The Centers for Medicare & Medicaid Services (CMS) announced its intent to delay the Radiation Oncology (RO) Model to July 1, 2021. The delay is included in the 2021 Hospital Outpatient Prospective Payment (OPPS) Final Rule (CMS-1736-FC) as an interim final rule with a comment period.

Due to the delay, the following changes have been made to the RO Model:

• The first performance year (PY) will be from July 1 to Dec. 21, 2021.
• The model performance period will be 4.5 years.
• CMS expects the Model to qualify as an Advanced Alternative Payment Model (APM) and a Merit-Based Incentive Payment System (MIPS) under the CMS Quality Payment Program (QPP) beginning in the PY2.
• Certified Electronic Health Record Technology will be a requirement starting in PY2.
• The individual practitioner list will still be required in PY1, but it will only be used for QPP in PY1 to assign an automatic 50 percent score for the Improvement Activity performance category in MIPS for RO participants.
• RO participants must, beginning in PY2, collect quality measures data from Jan. 1, 2022, through Dec. 31, 2022, and submit in March 2023.
• The collection period for clinical data elements will begin on Jan. 1, 2022. The first submission of the clinical data elements for Jan. 1, 2022, through June 30, 2022, will be due in July 2022.
• A CMS-approved contractor will administer the CAHPS® Cancer Care Survey for Radiation Therapy beginning in October 2021 instead of April 2021.

An updated version of the RO Model FAQs to reflect these changes is available.

RO Model Billing Webinar Update
This webinar has also been postponed to Jan. 13, 2021. Call in information for this webinar can be found here.

For any questions not answered in this update, you can reach out via email to CMS at: radiationtherapy@cms.hhs.gov. Additional information about the RO Model, including all changes, can be found on its website.

Posted 12/3/2020

CMS Announces Resources + Office Hours for RO Model Participants

The Centers for Medicare & Medicaid Services (CMS) has released resources and reminders to help those participating in the Radiation Oncology (RO) Model. These resources include help with accessing and navigating the Radiation Oncology Administrative Portal (ROAP).

Upcoming Changes to the ROAP:

• Access to multiple RO Model IDs
• Low volume opt-out
• Ability to edit your profile information.

If you haven't already done so, CMS encourages you to register for ROAP as soon as possible. To register for ROAP, you will need your Model ID, Taxpayer Identification Number (TIN) for physician group practices and freestanding radiation therapy centers or CMS Certification Number (CCN) for Hospital Outpatient Departments, first name, last name, and email address of the designated primary contact in the appropriate fields.

If you do not know your Model ID, please contact the CMS Helpdesk (1.888.734.6433, option 5). Hospital Outpatient Departments should email or call with their CMS Certification Number (CCN), so it can provide the correct Model ID; physician group practices and freestanding radiation therapy centers should call the Helpdesk with their practice’s Taxpayer Identification Number (TIN) to retrieve the correct Model ID.

ROAP Office Hours
RO participants can call into standing office hours that have been set up for troubleshooting ROAP login issues. Office hour dates and times include:

• Tuesday, December 1 at 12:00 PM EST
• Thursday, December 3 at 12:00 PM EST

More dates are to be determined after Dec. 3, 2020. To join an office hour, join the Zoom meeting by following the link or by entering the Meeting ID (160 189 1276) and password (881584) on Zoom.

For additional information about the RO Model, please visit its website. Or read the ROAP User Manual and ROAP FAQs.

Posted 12/1/2020