The payments are episode based payments. The expectation is that the RO Model positively changes the patient experience by rewarding high-quality, patient care and incentivizes radiation oncology treatments which result in better patient outcomes. The RO Model payment system is changed to reimburse providers with two episode payments. There will be one RO Model payment at the start of an episode and another RO Model Payment at the end of the episode.
If everything goes well, CMS hopes these two payments will be similar to the fee-for-service payments from the past. In the long term it may simplify the billing process and expected reimbursement by providers. However, mistakes will be costly. In FFS, if you bill a code incorrectly, you could potentially lose reimbursement on that service. In RO Model Payments, if you bill incorrectly, you may lose reimbursement on the entire episode. It also means less EOB material to understand by the patient. For now though, RO Model billing has to include both fee-for-service and the new episode billing codes. This adds quiet a lot of work to the provider. It also requires exact timing to achieve reimbursement.
Iridium Suite medical billing software does have a solution to help providers. This automated solution will help radiation therapy centers easily be reimbursed for RO Model payments.
