Radiation Oncology Billing Services Can Use New QPP Tool

Posted by Robert Lynch on Jan 15, 2018 5:55:19 PM

Last week the Centers for Medicare & Medicaid Services (CMS) launched a new data submission system for clinicians participating in the Quality Payment Program. Clinicians can now submit all of their 2017 Merit-based Incentive Payment System (MIPS) data through one platform on the qpp.cms.gov website. Data can be submitted and updated any time from January 2, 2018 to March 31, 2018, with the exception of CMS Web Interface users who will have a different timeframe to report quality data from January 22, 2018 to March 16, 2018.  Clinicians are encouraged to log-in early to familiarize themselves with the system.

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Topics: Radiation Oncology Billing

Medical Necessity Updates for Proton Beam Therapy

Posted by Robert Lynch on Jan 8, 2018 11:08:55 AM

In July, the American Society for Radiation Oncology (ASTRO) updated its recommendations for medical insurance coverage for the use of proton beam therapy. Proton therapy offers a high degree of precision, which allows radiation oncologists to target an escalated dose of radiation directly on a tumor and spare nearby healthy tissue. New Bedford’s review of policy changes among large carriers, indicates that coverage is generally being extended to Hepatocellular cancer (no longer required to be treated in a hypofractionated regimen).  Radiation oncology billing services and prior authorization services should be aware of the changes. 

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Topics: Radiation Oncology Billing, Prior Authorization

The Long Tail of Radiation Oncology Prior Authorizations

Posted by Robert Lynch on Dec 12, 2017 3:14:20 PM

We’re often asked: “How quickly can you process prior authorizations?”.  The answer is “it depends”, but we owe our customers a more thoughtful explanation than that, so we’ll try a clarification in this blog.  We’re reluctant to use averages or other statistics that might be misleading, because prior authorization response times tend to occur in what statisticians call a “long tail distribution”. 

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Topics: Radiation Oncology Billing, Prior Authorization

Radiation Oncology Billing and the Encounter Form

Posted by Robert Lynch on Dec 5, 2017 1:24:45 PM

The radiation oncology encounter form grew to be a ubiquitous aspect of billing and collections. The forms were used to document services rendered by capturing the diagnosis and procedure codes, which served as the basis for billing and receipt of payment for services.  There were a lot of reasons the forms existed for so long.  Notably, they:

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Topics: Radiation Oncology Billing

Know Your MIPS or APM Reporting Options for 2017

Posted by Robert Lynch on Nov 29, 2017 5:23:18 PM

The Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive for physicians and other eligible clinicians.  MACRA is designed to provide incentives for value and improved outcomes through either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs).

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Topics: Radiation Oncology Billing

2017 Radiation Oncology Compensation

Posted by Robert Lynch on Nov 14, 2017 2:14:11 PM

The past few years have been favorable for Radiation Oncology compensation.  Modern Healthcare’s 23rd annual Physician Compensation Survey, reaching 6,550 healthcare organizations and nearly 346,000 physicians, found in 2016:

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Topics: Radiation Oncology Billing

Top Data Security Question for Your Radiation Oncology Billing Service

Posted by Robert Lynch on Nov 7, 2017 5:05:34 PM

The provision of The Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule that has generated the most discussion is the elimination of the “risk of harm” standard for breach notification. The breach notification regulations did not change, however the breach notification trigger changed substantially. 

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Topics: Radiation Oncology Billing

Three Things to Know about Radiation Therapy Prior Authorizations.

Posted by Robert Lynch on Oct 30, 2017 9:13:25 PM

Prior authorization is the requirement to obtain prior approval for the reimbursement of medical services, procedures, tests and specialist appointments.  An increase in prior authorization requirements in radiation therapy is placing administrative and financial burdens on many radiation oncology practices throughout the United States.  Some basics that radiation oncology providers should know include:

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Topics: Radiation Oncology Billing, Prior Authorization

Pending E/M Coding Changes & Radiation Oncology Billing

Posted by Robert Lynch on Oct 24, 2017 10:47:58 AM

Among the many provisions detailed within the 2018 Physician Fee Schedule Proposed Rule, CMS acknowledges that the current evaluation and management documentation guidelines create an administrative burden and increased audit risk for providers.

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Topics: Radiation Oncology Coding

Prior Authorization Trends in Radiation Therapy Billing

Posted by Robert Lynch on Oct 16, 2017 8:25:07 PM

Is your practice experiencing a growing burden from escalating prior authorization requirements?  Probably so.  We recently analyzed our data for multiple radiation oncology billing clients and discovered a significant trend.  Prior authorization requirements have increased each year for the past three years.  The authorization requirements varied considerably by client, but overall authorizations have increased approximately 20% during the past three years.  In 2015 our average client using authorization services, needed prior authorization for 26% of all courses of treatment.  During the same period in 2017 the ratio has grown to 31% of total courses of treatment requiring prior authorization.

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Topics: Prior Authorization

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