October 28, 2020

ACR Radiation Oncology CAC Network Discusses Medicare Coverage Issues

On Oct. 24, 2020, the American College of Radiology® (ACR®) Radiation Oncology (RO) Contractor Advisory Committee (CAC) Network held its annual meeting to discuss local Medicare coverage issues. Special guests of the ACR RO CAC meeting included leadership and staff of the Commission on Radiation Oncology and staff of the American Society for Radiation Oncology (ASTRO).

The virtual meeting was led by Laeton Pang, MD, MPH, FACR, Chair of the ACR Radiation Oncology CAC Network. Of the 160 total CAC Network representatives, 40 reps have an RO specialty designation. The meeting began by spotlighting updates to the CAC Network distribution list. Through state chapter outreach efforts, we seek to recruit new RO CAC members and young physicians to participate in important policy development and reimbursement discussions.

A top priority for the network remains the need to identify, review and comment on draft local coverage determinations (LCDs), Medicare issues and Medicare reform initiatives. Also, updates were provided on the radiation oncology payment model that will begin July 1, 2021, 2021. CMS proposed rules and audit activities that include radiation therapy services. There are several financial struggles including claims denials and bundling of services for both Medicare and Commercial payers impacting radiation oncology providers and access to patient care. To address reduced reimbursement concerns, legislative action and engagement with congressional champions may be required. We encourage ACR members to address concerns with their congressional representatives using ACR and ASTRO advocacy websites and resources.

ACR staff and the RO CAC Network have tracked the following local coverage topic areas for 2019–2020:

  • Prostate Rectal Spacers.
  • Proton Beam Therapy.
  • Intensity Modulated Radiation Therapy.
  • Stereotactic Radiation Therapy: SRS and SBRT.

The CAC structure provides a formal mechanism for healthcare professionals to be informed of the evidence used in developing LCDs and promotes communications between the Medicare Administrative Contractor and the healthcare community. CAC members serve in an advisory capacity as representatives of their constituency to review the quality of the evidence used in the development of LCDs. Our RO CAC reps will work with their Medicare Contractors to identify radiation oncology subject matter experts to provide input on local coverage development.

To remain effective, we need active CAC reps and liaisons engaged in this process. If interested in joining the CAC Network or learning more about its goals and priorities, please email Alicia Blakey at ablakey@acr.org.