PRINCIPLES PRINCIPLES OF BILLING, OF BILLING,

CODING, CODING, COMPLIANCECOMPLIANCE

IN RADIATION ONCOLOGYIN RADIATION ONCOLOGY

THE 17TH EDITION BMSi USERS GUIDE

PRINCIPLES OF BILLING, PRINCIPLES OF BILLING, CODING AND CODING AND

COMPLIANCE IN COMPLIANCE IN RADIATION ONCOLOGYRADIATION ONCOLOGY

BMSiBMSiDay One April 11, 2014

49 SLIDES

041314

INTRODUCTION TO THE BMSi SEMINAR SERIES

This set of slides will run This set of slides will run automatically during the time automatically during the time

you are settling in for the you are settling in for the morning sessionmorning session

These slides are for information These slides are for information purposes only, and are not part purposes only, and are not part of your CMEof your CME

BMSi SEMINARSBMSi is a division of Bogardus BMSi is a division of Bogardus

Medical Systems, Inc. Medical Systems, Inc.

This seminar is being sponsored This seminar is being sponsored and produced in part by and produced in part by

Bogardus Medical Systems IncBogardus Medical Systems Inc.

THIS IS BMSi SEMINAR # 123New York city, NY

Reformatted DesignBased on frequent requests from previous attendees to add more basic information up front for the new individuals, but also to enhance some of the more complicated billing issues for the experienced person, BMSi seminars has reformatted the design of our teaching program.

Reformatted Design

1.Experienced attendees do not need some of the basic material.

2.The new attendees are confused by some of the advanced material.

3.Dividing the seminar into 3 levels of teaching solves both problems.

Seminar Reformatted

•This seminar will consist of a new format, still utilizing 12 hours of education, but designed as; 1.A 2 hour introductory session for the beginner, 8:00-10:00 2.A concurrent 2 hour advanced session covering new topics, 8:00-10:003.The remaining 10 hours is the standard general session for all attendees.

Session DesignThe introductory session for the beginner, 2 hours on Thursday morning, will be extremely useful to those individuals who have less than one year’s experience with Radiation Oncology.

The concurrent advanced session covering new topics, 2 hours on Thursday morning, will be a comprehensive session covering some of the more difficult and specialized procedures that we encounter in compliance and billing.

The remainder of the seminar will be the standard general sessions for all attendees,

Reformatted Seminar Design

The remainder of the program, will cover the bulk of the present seminar

subjects in documentation, compliance, and billing.

At the request of many previous attendees, we have added an entirely new session on the

second day covering the technical aspects of hospital documentation and billing.

VIRTUIAL PROGRAM FORMAT

Dr. Bogardus will not be here in person, but he will be available and participating using a live video simulcast from the BMSi office in Oklahoma City.

This is a live two way communication, and the audience is encouraged to interact with the presenters as we have always done in the past.

Carl R. Bogardus, Jr., M.D., FACR, FASTRO CEO of Bogardus Medical Systems, Inc.

Dr. Bogardus is Professor, Clinical Director and Vice Chairman of the Department of Radiation Oncology at the University of Oklahoma. He has a career in business and consulting as the founder of Cancer Care Network, Inc. and Bogardus Medical Systems, Inc. Dr. Bogardus’ primary interest over the years has been the development of the Radiation Oncology Coding and Nomenclature System. In 2000, ONCOCHART was developed to meet the compelling need to insure that federally mandated policies and procedures are followed completely; and the productivity and profitability of Radiation Oncologists is enhanced Most radiation oncology billing done today follows the guidelines laid out in his publications.

Scott Simmons, President of Eagle Consulting

With an Associate Degree from Piedmont Technical College and a Bachelors Degree in Radiation Therapy from the Medical University of South Carolina, Scott began his career in the Jacksonville area as a staff therapist and, later, Chief therapist. After relocating to Georgia in an administrative position, Scott’s facility underwent a Medicare audit, leading to an interest in the business side of radiation oncology and a relationship with Cancer Care Network and Dr. Bogardus. In 2006, Scott formed Eagle Consulting, providing personalized “limited consulting service.”

Susan Vannoni, President of Radiation Oncology Consulting, LLC

Beginning as a radiographer in the 1970’s, Susan became a registered therapist in South Bend, Indiana, graduated with a B.S in Health Occupations Education from Indiana University, and in the 1980’s became the Program Director of the school of radiation therapy at Memorial Hospital. She received her Masters Degree in Business from Notre Dame. She became Director of Radiation Oncology in 1994 at St. Joseph’s in Phoenix. She entered into management of FSC’s in 2001. During this time, she became associated with Dr. Bogardus, passed the first ROCC exam given, and became a consultant with Cancer Care Network until 2006, when she opened her own consulting service, Radiation Oncology Consulting.

Kevin Ewalt President and CEO of RADMAX, LTD.

Kevin has over twenty years of experience in the healthcare industry including UCLA Medical Center (Los Angeles, Calif.), Saint John’s Hospital and Health Center (Santa Monica, Calif.) and serving as Director of Operations for East Texas Medical Center (Tyler, Tex.). During his years working in hospitals he has gained expertise in center supervision, project planning, report production, budget planning and medical billing.Kevin is also an accomplished musician and still plays music when time permits. He formed his company, RADMAX in 2004.Kevin’s ability to think creatively as well as analytically makes him a unique leader and instrumental in RADMAX’s success.

BMSi Seminars Basic Principles of Documentation,Billing, Coding, and Compliance in

Radiation Oncology

Carl R. Bogardus, Jr., M.D., FACR, Carl R. Bogardus, Jr., M.D., FACR, FASTROFASTRO

Professor, Dept. Radiation OncologyProfessor, Dept. Radiation Oncology

Director of Clinical ServicesDirector of Clinical Services

University of Oklahoma HSCUniversity of Oklahoma HSC

Oklahoma City, OKOklahoma City, OKModified For 04-10-1449 Slides

The front cover of your book has the unique serial number

of your copy of the book

17.003.4454Copy number of your book

Printing of this version of the book

Edition of this manual

Radiation Oncology Seminar Manual

Print full name

Billing Site/Center

Address

City, State, Zip Code

DID YOU REMEMBER TO FILL IN YOUR

OWNERSHIP INFORMATION?

THIS IS YOUR BOOK

Sponsors of the Documentation, Billing, Coding, and Compliance

seminar seriesThis seminar series is very expensive This seminar series is very expensive to produce and maintain for many to produce and maintain for many

reasons.reasons. All of our costs are more than your combined All of our costs are more than your combined tuitions for the limited number of professionals tuitions for the limited number of professionals attending this highly specialized seminar series. attending this highly specialized seminar series. We are able to hold the tuition stable and We are able to hold the tuition stable and continue to provide these seminars through the continue to provide these seminars through the generous support of our sponsors, who help generous support of our sponsors, who help make all of this possiblemake all of this possible.

Please acknowledge their contributions to your

educational experience.

1-A

Jeff Carlin of BMSi is available to meet with you and demonstrate the features of ONCOCHART

If you are interested in further information on ONCOCHART for your practice, a WEB demonstration can be arranged

Flyers, a summary booklet, and demonstration CD, are available in the lobby

ONCOCHART WAS THE FIRST ELECTRONIC HEALTH RECORD PROGRAM IN RADIATION

ONCOLOGY TO BE FULLY CERTIFIED

Now certified for meaningful use TWO.

BMSi was number 9 in the country to achieve this milestone.

1-C

Scott Simmons is Scott Simmons is the owner of Eagle the owner of Eagle Consulting, and Consulting, and is a regular lecturer is a regular lecturer at the BMSi at the BMSi seminarsseminars

Scott is available to Scott is available to help you and your help you and your practice with the practice with the many complex many complex issues of today's issues of today's world of billing and world of billing and compliance as a compliance as a consultant, onsite or consultant, onsite or in a limited online in a limited online consulting consulting arrangementarrangement

1-D

Susan owns her business of Radiation Oncology Consulting. She has many years of experience in the management of centers, and the knowledge this brings to her consulting business.

Susan is available to do on site consulting and also limited on line consulting work

Susan Vannoni is a regular lecturer at the BMSi seminars.

BMSi Publishing

• Production Design Carl R Bogardus, Jr MD

• Book Editor in Chief Carol Gravlee

• Director of Printing Colleen Mallory

• Manager of Compliance Lynn Miller, BsRn, Onc

• Seminar coordinator Carol Gravlee

American Medical Association (AMA)

CPT, ICD-9American College of Radiology

(ACR)American Joint Committee on

CancerOncochart (BMSi)

Section 1Introduction, Credits & Disclaimers

Covered by pages 14-18

NOTICE OF PERMISSION

All patient related material, to include photographs of the patient, the patient’s tumor site, and all associated electronic representations of patient material is being used as a scientific presentation with the complete understanding of the patient and with their full written consent. A signed, dated, and witnessed consent form is on file in the department of radiation oncology.

NIB

BMSi SEMINARS Commercial Discloser

BMSi Seminars is a production of Bogardus Medical Systems, Inc., BMSi is owned in

part by C. R. Bogardus, JR , M.D. BMSi is responsible for the development of the

Oncochart Program, which is used extensively throughout this Seminar for the sole purpose of illustration of proper

documentation

1-13

COPYRIGHT LEGAL OPINION

This use of a limited number of CPT codes constitutes “FAIR USE” as defined under Chapter 1, Sect 107 US copyright law.

This Seminar Manual is intended to be a

supplement rather than a replacement for the

American Medical Association’s

Physician’s Current Procedural Terminology

(CPT).

It should be noted that It should be noted that the information the information

contained in this manual contained in this manual does not constitute law does not constitute law

or HCFA policy.or HCFA policy.

WARNING DISCLAIMERWARNING DISCLAIMER

• Reimbursement policies vary widely between insurers, and even the same insurer in different parts of the country

• Reimbursement policies are subject to change without notice.

• The information in these books may be current at the time of the seminar, but can be out of date by the time of your use.

• If in doubt check with your insurer.If in doubt check with your insurer.

Meeting Your Educational Needs• Radiation oncology billing is the most complex of all medical

billing scenarios.• To be able to correctly bill radiation oncology procedures, you

must first have a basic understanding of the science of radiation oncology.

• The science leads to procedures.• All procedures must be medically compliant.• Compliant procedures may be billed.

• This book and the accompanying course work form only a basic primer in the science of radiation oncology, but it is an advanced course covering the requirements for documentation..

Section 1,Page13

THE GOAL OF THIS SEMINAR HAS BEEN :

• TO TEACH:TO TEACH:–DocumentationDocumentation

–ComplianceCompliance

–Charge captureCharge capture

–BillingBilling

1-13

CONTINUING EDUCATION CREDITS

• 12 CEU AMA Category II CreditsCategory II Credits• 12 CEU ASRT Credits• 12.5 CEU AAPC Credits• 12 CEU ROCC Exam Credits

PARTICIPANTS ARE TO CLAIM ONLY THOSE CREDITS THAT APPLY TO THEIR SPECIALTY, AND

COMMENSURATE WITH THE EXTENT OF THEIR PARTICIPATION IN THIS ACTIVITY. YOU MUST YOU MUST COMPLETE AND SIGN THE EVALUATION COMPLETE AND SIGN THE EVALUATION FORM TO RECEIVE YOUR EDUCATIONAL FORM TO RECEIVE YOUR EDUCATIONAL

CREDITSCREDITS

PROGRAM MODIFICATIONS

• At the request of previous audiences, At the request of previous audiences, and in response to your critique forms, and in response to your critique forms, changes are often made to the program.changes are often made to the program.

• One of these to save your valuable time, is that we are covering the basic introductions as you get settled in the room.

• The required disclaimers are in the book and do not need to be re-stated.

Follow the program guide.The lecture series will not sequentially follow the book chapters. This is necessary to allow the correct amount of time for each section to be fully presented.

PROGRAM GUIDE NOTICE!! NOTICE!!

The program guide allows you to follow the sequence of the lectures, the person doing the presentation, and the section of the User’s Guide where the lecture material is located.

SLIDES AND PAGE NUMBERS MAY NOT MATCH

EXACTLY

This lecture is constantly changing and it is difficult to keep all the slides correlated with the page numbers. In any event they may be off only a page or two, let us know at the time if you cant find a section

There are multiple reasons why the number on the slide may

not match the page in the book.• The primary reason is related to multiple

modifications of the slides and book chapter to meet new rules and current thinking.

• An equally important reason is related to paraphrasing and shortening the data on the slide to the point where it may be difficult to recognize where it came from in the book.

• And some slides are just not in the book, NIB.

NAVIGATION AID TO THE FORMAT OF YOUR BMSi

SEMINAR MANUAL

• Each section starts with new Each section starts with new page numbers. page numbers. Be sure you are in Be sure you are in the correct section of the bookthe correct section of the book

• Most of the slides have reference page numbers on the slide.

32

Page 32 Page 32 Section 5 V 17.001Section 5 V 17.001

SLIDES NOT IN BOOK

• SOME OF THE SLIDES IN THIS LECTURE ARE NOT IN THE BOOK

• THEY HAVE BEEN ADDED TO MAKE THE LECTURE MATERIAL MORE UNDERSTANDABLE, AND FOR CLARIFICATION OF DOCUMENTATION AND ILLUSTRATIONS OF MEDICAL NECESSITY

NIB

NIB

VERSION NUMBER

• Some sections of this book are unchanged from previous printings and may have different version numbers listed on the bottom of each page of the section.

• This is not an error, sections that have been reworked will have a new number, while older sections may retain the original number.

This seminar will be followed in two weeks on April 24, 2014 with a live two way web based seminar follow up, exclusively for attendees of this seminar and their office staff, see Carol for details of participation

WHAT DID WE LEARN?

Please discuss this seminar with your office staff and come up with questions or suggestions about what you learned, or what you want to know more about. Send in your questions and I will discuss them at the WHAT DID WE LEARN session.

Today's Morning Schedule• 8:00-10:00 Basic introduction to radiation oncology • 8:00-9:00 History, terms, equipment……… section 14 • 9:00-10:00 CPT, CCI, Modifiers…………….. section 2

• 8: 00-10:00 Advanced techniques radiation oncology• 8: 00-9:00 Brachy therapy………………….. section 12• 9:00-10:00 SRS, SBRT, proton ……………..section 10

• 10:00-10:15 Break

• 10:15-11:15 E/M procedures…………………. section 5• 11:15-12:00 EHR, meaningful use …………...section 3

• 12:00-1:00 Lunch, ONCOCHART demonstration

Today's Afternoon Schedule

• 1:00-1:30 Updates………………………….. Not in Book• 1:30-2:00 Clinical treatment planning……… section 6• 2:00-3:00 Simulation…………………………... section 7• 3:00-3:15 Break• 3:15-4:00 Dosimetry…………………………… section 8

• 4:00-5:00 Treatment delivery………………… section 9

PLEASE TURN PLEASE TURN OFF,OFF,OR SET ON OR SET ON SILENT.SILENT.

• SEMINARS IN 2014• February 20-21 Orlando• March 20-21 Anaheim• April 10-11 New York City• May 16-17 San Antonio• June 12-13 Nashville• July 24-25 Colorado Springs• August 14-15 Chicago• October 2-3 New Orleans• November 7-6 Miami• December 3-4-5 Las Vegas

PRINCIPLES OF BILLING, PRINCIPLES OF BILLING, CODING AND CODING AND

COMPLIANCE IN COMPLIANCE IN RADIATION ONCOLOGYRADIATION ONCOLOGY

BMSiBMSi

END AUTO RUNDay One

2014

THE SEMINAR WILL START IN A FEW

MOMENTS, THANK YOU