These achievements are part of our ongoing commitment to our mission to provide the highest quality products that meet or exceed our client’s expectations.

Craig Laughton and I would like to introduce to you a new service that a very good friend of ours Kevin Ewalt, launched at last years ASTRO 2004 show. RadMax Ltd. is a new State of the Art Radiation Oncology Billing Service that we believe will be a great asset to your Radiation Oncology physicians and your cancer treatment center. In the interest of full disclosure, Craig and I share a minority interest in this new service as minority general partners and will provide occasional marketing consulting and assistance with technology implementation.

The Founder of RadMax, Ltd., Kevin Ewalt has over 14 years of experience in the healthcare industry and most recently served as Director of Operations for the East Texas Medical Center Cancer Institute. During his years in the industry, he has gained expertise in center supervision, project planning, report production, budget planning and medical billing. Kevin has now dedicated his focus to radiation oncology billing because he has a proven track record of maximizing radiation oncology facilities revenue while providing the highest quality customer service.

Kevin’s mission is to maximize his client's income and be a one stop source for billing, coding and AR management needs. Kevin will accomplish this through quality staff, education, persistence, hard work and through the utilization of the best technology available.

We encourage you to forward the website address provided below to your administrator or appropriate Radiation Oncologist so they may investigate how RadMax, Ltd. can be a vital asset in managing all their AR management & billing needs. RadMax Ltd. will be exhibiting at ASTRO 2005 Booth # 1528. Additional information can be found at RadMax, Ltd.’s website: www.radmaxonline

Craig and I have great confidence that Kevin and his staff will be a great asset to your facility.

Thank you for your consideration.

Sincerely,

Jim Dube: President
Craig Laughton: CEO
LifeLine Software, Inc.
3085 Stonegate Blvd.
Tyler, TX. 75703

“It was quite an endeavor trying to build a solution into RadCalc that would be both easy to use and accurate. After many months of thought and effort, I believe we have finally achieved these goals” stated Craig Laughton, LSI’s CEO and developer of the product.

LSI would like to thank all MIMIC clients for their patience as we endeavored to provide the best solution to meet their needs and we extend our thanks to Nomos for their contribution to this achievement.

MIMIC support will be available for demonstration at this years ASTRO meeting in Atlanta, booth 544. MIMIC users may also request a current demo CD Rom by contacting LSI’s sales office. A version of RadCalc with MIMIC support will be officially available shortly after the ASTRO meeting.

Jim Dube, LSI’s President notes, “At LifeLine Software we are driven by our commitment to continuous improvement in all we do, so by enhancing RadCalc®’s functionality we continue to offer the most complete and up to date IMRT verification software to our clients. Adding MIMIC support is another example of our commitment to meet our customers’ needs.”

RadCalc® Users Will Benefit From New 4.3 Version

Powerful IMRT QA software now provides even more enhanced features

RadCalc® 4.3 offers several new enhancements that continue to provide physicists, dosimetrists, and their colleagues’ state of the art MU and point dose verification that is fast, accurate, and easy to use.

Just a few of the enhancements include; improved IMRT dose calculation and revisions to the MLC Data tab so that users can magnify the view of the fluence map, display control point data, edit MLC leaves easier, display the modulation factor, %diff for point, and volume averaged dose. We added the ability for users to edit control point data, display volume average dose points and locations, display dose per control point, click on the fluence map and display point and dose information, and added a simulate button to simulate delivery.

Other enhancements include adding an electronic format for printouts and added preferences for the default print layout and date format for printouts. Printouts now include additional calculation information as well as an optional comments section.

Jim Dube, LSI’s President notes, “At LifeLine Software we are driven by our commitment to continuous improvement in all we do, so by enhancing RadCalc®’s functionality we continue to offer the most complete and up to date IMRT verification software to our clients.

We see RadCalc® version 4.3 as a demonstration of our commitment to provide the most comprehensive independent MU & point dose verification software product in the world. As the number of RadCalc® users grow, we have the opportunity to respond to more ideas on how to meet our customers’ needs. We believe that listening and responding to our clients needs has helped us maintain our leadership role in the MU verification software market.”

Lifeline Software, Inc., of Tyler, Texas, is a privately held software company servicing radiation oncology centers worldwide. LSI provides RadCalc®, the first FDA approved quality assurance software for independent IMRT treatment plan verification. RadCalc® offers a more efficient process for MU and point dose verification by utilizing interfaces with existing RTP and Verify and Record systems. For more information, visit www.lifelinesoftware.com, or contact Jim Dube at: 866-592-1343, Opt 1.

REPORTING 77300 with IMRT:

As a result of the ACR/ASTRO Joint Economics Committee efforts, the Centers for Medicare and Medicaid Services will delete the correct coding initiative edit that bundles IMRT planning CPT® code 77301 with the dosimetry calculation CPT® code 77300. CMS will make retroactive payments for any claims denied based on this CCI edit. The Joint Economics Committee has been working on this effort for several months and is pleased to have the physics calculations recognized for separate payment.

The deletion will appear in CCI version 9.2 scheduled for implementation on July 1, 2003 and payments will be retroactive to the date when this edit was developed April 1, 2002. Therefore after July 1, 2003 any claims that were denied based on this edit may be resubmitted for payment. Please contact your local Medicare carrier for more details regarding claims resubmission.

DOCUMENTING 77300 for IMRT. Although the above ruling does provide for reimbursement for the basic dosimetry code 77300 when performing IMRT, all work must be clearly ordered and documented in the medical record. When performing IMRT you cannot calculate an actual monitor unit at the central axis by a hand calculation due to the inverse planning performed by the computer. The computer accounts for the fact that many tiny pencil-thin beams project to a nominal 1 cm or less at the treatment unit isocenter as well as multileaf collimator (MLC) that are used to cover the prescribed tumor volume.

When performing audits we have encountered situations where the organization automatically reported a basic dosimetry for each monitor unit that the IMRT computer plan generated, but they did not have any corresponding calculations available in the medical record. You may only report work that is ordered and subsequently performed.

There are multiple software applications that are available that can perform a validation calculation. CCI is most familiar with the RadCalc® application that includes an IMRT Validation Utility that provides the verification of MU or point dose calculations for IMRT based treatment plans. The IMRT utility allows you to import from your treatment planning system either static or dynamic MLC leaf sequences.

A dedicated calculation must be available in the medical record for each basic dosimetry code that is reported. For example, if you have a 6 portal arrangement you can report 6 basic dosimetry (77300) calculations, providing that you have evidence of the calculation confirmations in the medical record. Be sure that the physician orders the dosimetry and signs and dates the calculations.

The reimbursement for this code alone is significant. A standard IMRT case may have approximately 6 portals. The unadjusted reimbursement rate for code 77300 x 6 is demonstrated below:

Reimbursement	Rate	Total x 6
APC	$84.39	$506.54
Technical Medicare	$51.14	$306.83
Professional Medicare	$31.64	$189.94
Global Medicare	$82.78	$496.67

As demonstrated above, the basic dosimetry reimbursement alone will have a major impact on your collections. If you are performing IMRT and don't have a computation tool, it is recommended that you consider adding this purchase to your budget. Confirming the calculations is good both QA and a sound fiscal investment.

For more information, please contact:

Deborah I. Churchill, President
Churchill Consulting, Inc.
Phone:860-663-5630
Fax:860-663-5633
Email:ChrchlCCI@aol.com
Website: www.ChurchillConsulting

An expert in oncology billing, Deborah regularly conducts CPT Billing Seminars for Radiation Oncology. In addition to private seminars Deborah has also conducted seminars for the New England Society for Radiation Oncology, AAMD, AAPM, SROA and OROS. Deborah has conducted focused seminars for organizations that include IMPAC Medical Systems, ELECTA, MDS Nordion, Medical Technology Management Institute and Radionics. Deborah has published articles in Advance Magazine, Oncology Nursing Society and is a contributing editor for The Coding Institute.