Subpart B. Subpart B—Radiation Oncology Model

• General

  • SECTION § 512.200 - Basis and scope of subpart.
  • SECTION § 512.205 - Definitions.

• RO Model Participation

  • SECTION § 512.210 - RO participants and geographic areas.
  • SECTION § 512.215 - Beneficiary population.
  • SECTION § 512.217 - Identification of individual practitioners.
  • SECTION § 512.220 - RO participant compliance with RO Model requirements.
  • SECTION § 512.225 - Beneficiary notification.

• Scope of RO Episodes Being Tested

  • SECTION § 512.230 - Criteria for determining cancer types.
  • SECTION § 512.235 - Included RT services.
  • SECTION § 512.240 - Included modalities.
  • SECTION § 512.245 - Included RO episodes.

• Pricing Methodology

  • SECTION § 512.250 - Determination of national base rates.
  • SECTION § 512.255 - Determination of participant-specific professional episode payment and participant-specific technical episode payment amounts.

• Billing and Payment

  • SECTION § 512.260 - Billing.
  • SECTION § 512.265 - Payment.
  • SECTION § 512.270 - Treatment of add-on payments under existing Medicare payment systems.

• Data Reporting

  • SECTION § 512.275 - Quality measures, clinical data, and reporting.

• Medicare Program Waivers

  • SECTION § 512.280 - RO Model Medicare program waivers.

• Reconciliation and Review Process

  • SECTION § 512.285 - Reconciliation process.
  • SECTION § 512.290 - Timely error notice and reconsideration review process.
  • SECTION § 512.292 - Overlap with other models tested under Section 1115A and CMS programs.
  • SECTION § 512.294 - Extreme and uncontrollable circumstances.