Radiation Oncology Billers – Don’t Let RO Model Make You Crazy - Shavara

Radiation oncology practice administrators have a significant amount of homework to do preparing for the RO Model. They have to sign up for the RO Model portals: Radiation Oncology Administrative Portal (ROAP) and The RO Model Secure Data Portal. They will need to use these tools to anticipate and verify the RO Model reimbursement.

However, the day-to-day challenge is on the shoulders of the billers. Familiarity will the RO Model eligibility rules is crucial. Even with all the rules memorized, applying those rules will be a big stressor on a daily basis.

At Shavara, we have created Iridium Suite billing software to take away that stress.

Let’s look at some of the tools:

When a treatment course is entered for a Medicare patient, Iridium Suite checks the diagnosis against the RO Model Included Cancer ICD-10 Codes and will warn the biller that the patient could be included in the RO Model.
If the patient treatment course is designated as included by the biller, Iridium Suite will capture the RO Model M codes for the diagnosis when the trigger charges are entered (treatment plan and treatment delivery). It will also hold from submission all the included Radiation Therapy fee-for-service codes until the end of treatment course.
For treatment courses that fall into the excluded modality (like brachytherapy), Iridium Suite will automatically add the GB modifier to the included RT codes, indicating these are to be considered fee for service. The excluded RT codes will not have the GB added.

4. For patients with a complicated cancer history, treatment courses for excluded diagnoses with a historical included diagnosis attached to the CPT codes, Iridium Suite will automatically add the GB modifier indicating the treatment course is to be considered fee for service.

RO Model billing is not the only challenge you face. Iridium Suite has been serving the radiation oncology specialty for over 20 years. We are designed to streamline your workflow and optimize reimbursement.

Revenue Cycle Management: Accomplished.