Oncology Billing Changes In 2023
                     Oncol
ogy 
Billing 
Chang
es In 
2023
INTRODUCTION
❏ The promptness of your billing, account 
follow-ups, and reimbursements have a 
significant impact on your oncology 
practice’s financial performance. Being in 
compliance with all cancer billing regulations 
is essential to ensuring your facility’s 
profitability. However, given how frequently 
oncology medical billing regulations change, 
it might not always be simple to remain 
compliant.
❏ Let’s glance through several 
Oncology Medical Billing changes that took 
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1.  Payments for radiation oncology and 
hematology/oncology are being reduced
Oncology Billing 
Changes In 2023
●  Due to changes in RVU, payments to doctors who specialize 
in radiation oncology and hematology/oncology are 
anticipated to fall by 1% in 2023. The impact on 
hematology/oncology can be attributed to changes in 
practice expense (PE) RVUs, whereas the impact on radiation 
oncology can be ascribed to changes in work RVUs. The 
simultaneous termination of the interim 3% payment rise 
that #physicians received in 2022 to assist lessen the 
effects of the epidemic may have an even greater effect on 
#oncologists.
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2.  CMS finalized new MIPS quality measures for 
cancer
● For the CY 2023 perOfonrmcaoncloe pgeyri oBd/i2l0l2in5 gMI PS payment year, the 
CMS included new cCanhcaern-reglaetesd  IMnIP S2 q0u2al3ity metrics. One of the 
new measures tracks the number of patients with colorectal, 
endometrial, gastroesophageal, and small bowel carcinoma who 
have undergone testing for mismatch repair or microsatellite 
instability. Another measure keeps track of whether patients taking 
checkpoint inhibitors have been given medication for colitis or 
diarrhea.
● The agency also increased the number of measures for the 
Oncology/Hematology Specialty Set and the Radiation #Oncology 
Specialty Set, including adult immunization status, use of high-risk 
medications in older adults, CAHPS for MIPS clinician/group survey, 
and screening for depression and follow-up plans.
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3.  The 340B payment rate is rising to ASP +6% per 
2023 OPPS/ASC
● Despite CMS’s initiaOl pnrocposlaol gtoy k eBepi ltlhien 3g4 0B-acquired medicine 
payment rate at ASCP -h22a.n5%g feors C IYn 2 02230, 2th3e agency increased the 
rate to ASP +6% in the final rule. This announcement follows the 
Supreme Court’s recent ruling to reject the CMS-implemented 340B 
#payment cut to ASP-22.5% in American Hospital Association v. 
Becerra. The Supreme Court ruled that because CMS did not poll 
hospitals to ascertain their typical medication acquisition prices, 
the payment cut was unlawful.
● For hospitals taking part in the 340B program, this means an 
increase in revenue from cancer and other medicine 
#reimbursement of around $2 billion. CMS had to lower the 
payment rates for non-drug services by 3.09%, which will have an 
impact on both 340B and non-340B hospitals, in order to maintain 
budget neutrality.
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4.  The ASC Covered Procedures List is being updated 
to include lymph node biopsy or excision and modified 
radOicnalc molaosgteyc tBoimllyin (gC PL)
Changes In 2023
● Through its examination of the procedures, discussions with 
interested parties, and consultations with clinical advisers, CMS 
came to the conclusion that axillary lymph nodes and biopsy or 
excision of the lymph node(s) can both be safely carried out in 
the ASC setting.
● After receiving feedback from commentators, CMS changed its 
initial proposal to include only lymph node biopsy or excision on 
the CPL and added modified radical mastectomy in the final 
regulation. These treatments can be performed in an ASC 
setting thanks to the addition to the CPL, but they are not 
required to.
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5.  The reporting period for the new Breast Cancer 
Screening RecallO Rnacteosl oOgQyR B mileliansgu re (OP-39) begins 
Chaning CeYs  2In0 223023
● The #Hospital Outpatient Quality Reporting (OQR) Program’s new 
Breast #Cancer Screening Recall Rates OQR measure (OP-39), 
which was finalized last year, will begin to collect data in CY 2023 
for a three-year reporting period.
● Since this is a claims-based metric, providers are not required to 
submit any specific information. The percentage of screening 
mammography and digital breast tomosynthesis (DBT) studies that 
are followed by a diagnostic mammography, #diagnostic DBT, 
breast ultrasound, or breast #MRI study conducted in an outpatient 
or office setting on the same day or within 45 days is what is used 
to calculate it at the facility level.
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6.  CMS is introducing a brand-new MIPS Value Pathway 
(MVP) for oncology dubbed Advancing Cancer Care
Oncology Billing 
●  The optional AdvanCcinhga Cnangceer sC aIren M 2VP0 i2s d3esigned for oncology and 
#hematology practitioners and focuses on providing core cancer care 
management and treatment. It includes two Qualified Clinical Data 
Registry indicators that are focused on patient experience, end-of-life 
care, and appropriate #diagnosis and treatment, along with ten cancer-
specific quality measures. A Total Per Capita Cost metric and 13 
improvement initiatives are also included.
● The standards of CMS’s new Enhancing #Oncology Model (EOM), 
including as guideline-concordant therapy, 24/7 availability to doctors, 
and advanced care planning, overlap some with the improvement 
initiatives of the Advancing Cancer Care MVP. Since we are aware that 
the EOM quality measures will concentrate on patient experience, end-
of-life care management, and other related areas, it is also possible 
that there will be overlap between the quality measures for the two 
programs.
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● It is assumed thaFt ibnilliangl  is effectively handled internally in oncology. However, the truth is that many #oncology practices 
are unable to simRueltaflneoucstlyi opronvside high-quality care and 
manage the intricate and time-consuming billing procedure. 
● Your Medical practice would be better off outsourcing this 
specific task. By 
Outsourcing Oncology Medical billing and coding, your clinic 
may free up time from non-essential tasks and devote it to 
keeping up with the rules and requirements for cancer billing, 
which are constantly changing. Even better, you can increase 
your bottom line by maintaining strict follow-ups on #claims.
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● Many clinics have outsourced their medical billing and coding to 
third party specialists in response to the growing laws and 
regulations and inC aon enffocrtl tuo reduce labor costs. 
● Many people find thats ouitosonurc ing the management of their 
medical bills is an efficient method to boost revenue and 
reclaim control. Pick the ideal medical billing industry and watch 
your revenue management cycle tap profits.
● If you’re looking for the ideal partner, Medisys Data Solution, 
the
 leading Medical Billing Outsourcing Services Provider In the US, 
is merely one click away! What is stopping you from choosing 
the Medical Billing Services Outsourcing company? We bet 
nothing!
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Why choose Medisys Data 
●SHoiglhuly tqiuoalinfiesd  pfroofres sMionealds wicitha elx tBenislivlei ng 
knowledge of medical and DME billing
● Easy and hassleS-ferere vonibcoearsdi?ng  for new 
customers
● Excellent control over pending, and rejected 
claims and receivables
● Communication that is smooth and open at every 
stage of the medical billing 
● Devoted, knowledgeable, and certified 
medical billing and coding team for your DME 
facility with top-notch claim management system
● Your questions and clarifications will be answered 
immediately and in real-time
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About Us
      Medisys Data Solutions is a leading 
medical billing company providing 
complete assistance in medical billing and 
coding. We can assist you in receiving 
accurate insurance reimbursement from 
private and government payers. With our 
services like benefits verification and 
credentialing & enrollment, you can add 
more providers in your practice. To know 
more about our specialty specific medical 
billing and coding services, contact us at 
[email protected]/ +1 888-720-8884 .
   GET IN TOUCH
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        Address:
Medisys Data Solutions Inc.
8 The Green STE A, Dover, Delaware 19901,USA
Email: [email protected]
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