Simul Parikh, Medical Director at Lake Huron Medical Center, and Medical Director of OncoHealth, shared a post on LinkedIn:
“Community radiation oncology is being ravaged.
Late last year, I warned that the 2026 coding and billing changes were a trap. While our specialty societies were sanguine-pointing at ‘top-line‘ numbers and projecting a ‘few percent‘ change-those of us on the ground saw the storm clouds.
We are now being ravaged. The reality is far worse than the predictions:
– The IGRT ‘Bundle’ Trap: Practices weren’t told to renegotiate technical component rates into the new delivery codes. The result? A massive, uncompensated revenue drain.
– 77387 wasn’t assigned a value for many hospitals and so physicians are seeing zeroes on their True Up reports and there appears to be no rush to fix them.
– The 77387 modifier is not working as planned and people are not getting reimbursed for this, causing further chaos. While we spend hours appealing denials for a modifier that they told us to use, our cash flow is being strangled. It’s not a transition, it’s a shakedown.
– The 77412 Myth: We were told this would cover complex, multi-isocenter treatments and utilizing active motion management, allowing for 35% of our cases to be treated at that level of care. Instead, I (and many of you) am facing repeated, systematic denials.
– They told us these codes would be ‘agnostic’ with regards to 3D and IMRT. That’s a joke. Calling this billing structure agnostic is like Jesus, Muhammad, and Maimonides sitting down to talk theology-they they might all agree on the ‘big picture,’ but the second you look at the fine print, the consensus disappears and you’re the one being excommunicated from your own revenue.
– The care delay is the most I have seen in my 15+ year career. The moral injury I feel on a daily basis is contributing to sense of failure and disgust.
Why does this matter? Because ROCR will be the final stake in the coffin. Fee-for-service is the only thing left protecting the technical integrity of RadOnc.
If we move to case rates, the ‘race to the bottom‘ begins. When you incentivize the least amount of fractions and skip out on high-quality IGRT/SGRT or active motion management because they don’t ‘pay’, quality of care will suffer.
Who wins in a ROCR world?
– Large AMCs with commercial leverage.
– PPS-exempt and Proton centers.
– Those with financial ties to the transition.
The rest of us? We’re Charlie Brown. Every year, we think Lucy (CMS/Payers) won’t pull the football away. Every year, we run full speed, and every year, we end up on our backs.
Stop being Charlie Brown. Do not support ROCR. It is not a solution; it is an exit ramp for quality care.”
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