Radiation Oncology Charges Projected to Drop 2% in 2019

Posted by Robert Lynch on Jul 17, 2018 5:16:46 PM

On July 12, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare Physician Fee Schedule (PFS) addressing Medicare payment and quality provisions. CMS estimates that the physician rule will decrease payments to radiation oncology and radiation therapy centers by 2% from 2018 to 2019. Table 94 of the Proposed Rule shows the CY 2019 PFS Estimated Impact on Total Allowed Charges by Specialty.  Click to view or download Table 94: CMS-1693-P Table 94

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Topics: Radiation Oncology Billing

Unauthorized Fractions:  To Bill or Not to Bill?

Posted by Robert Lynch on May 23, 2018 4:57:44 PM

We’ve been writing extensively on the growing trends in prior authorizations in radiation therapy and more recently we’ve been presented with the question of how to bill for unauthorized fractions.  It is becoming more common for managed care plans to contest the fractionation schedules ordered by the radiation oncologist.  These payers, or their utilization management companies, may authorize only a certain number of fractions for certain diagnosis and treatment courses. 

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Topics: Radiation Oncology Billing, Prior Authorization

Best Practices Staffing Prior Authorizations

Posted by Robert Lynch on May 16, 2018 3:08:54 PM

Prior authorizations (PAs) in radiation oncology have grown over 20% in the past few years and more and more providers are having difficulty keeping up with the administrative burden of managing the PA process.  Often in radiation oncology, there is a practice administrator who might also be tasked with processing PAs.  However, managing PAs on a part time basis has become increasingly more difficult because each health plan may implement different requirements and clinical guidelines may change with a surprising frequency. 

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Topics: Prior Authorization

Re-engineering A/R Follow Up

Posted by Robert Lynch on May 8, 2018 6:50:30 PM

Business process re-engineering is a management approach that is based on completely rethinking how processes and workflows are configured rather than making minor adjustments to existing processes.   One key tenet of re-engineering is that to make dramatic improvements in results, sometimes you need to completely rethink how work is done.

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Topics: Radiation Oncology Billing

Applying Six Sigma to Radiation Oncology Coding

Posted by Robert Lynch on May 2, 2018 10:36:19 AM

Insurance companies are merging, healthcare plans are continuously changing, and patients are routinely changing plans trying to find affordable coverage.  All this coupled with growth in prior authorizations, leads to one of the more challenging environments ever for providers to try to increase collections from insurance companies.  One management methodology to help radiation oncology providers succeed is the Six Sigma concept of eliminating non value-added time.

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Topics: Radiation Oncology Coding

Two Things to Know About ePA in Radiation Oncology

Posted by Robert Lynch on Apr 23, 2018 3:50:34 PM

We have consensus!  Prior Authorizations need to improve and improve quickly.  So says a collaboration of the AHA, AHIP, AMA, APhA, BCBSA, and MGMA who have announced a Consensus Statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

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Topics: Prior Authorization

Submit MIPS Data With These Ten Easy Steps

Posted by Robert Lynch on Mar 20, 2018 4:27:29 PM

March 31 is the deadline for submitting data for the 2017 Merit-based Incentive Payment System (MIPS) performance period.  If your radiation oncology billing service doesn't provide MIPS reporting for you, it's time to get moving.  With less than two weeks to go before the submission deadline, we want to share these ten easy steps from CMS to help your practice take advantage of this incentive.

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Topics: Radiation Oncology Billing, MIPS

Avoid Increased Prior Authorizations with HCPCS Modifier QQ

Posted by Robert Lynch on Mar 12, 2018 3:34:26 PM

Effective July 1, 2018, HCPCS modifier QQ (Ordering Professional Consulted A Qualified Clinical Decision Support Mechanism For This Service And The Related Data Was Provided To The Furnishing Professional) is available for reporting. The modifier may be:

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Topics: Prior Authorization

Prior Authorizations Soar, Aetna's Medical Director Snores

Posted by Robert Lynch on Feb 20, 2018 3:35:57 PM

New Bedford Corporation has been reporting on the growing frequency of radiation oncology prior authorizations.  Although we’re well aware of the growing scrutiny and the need to submit medical records to gain approval for certain courses of treatment, we never imagined an Aetna medical director would admit to never reviewing medical records during nearly three years of making coverage decisions.

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Topics: Prior Authorization

Trends in Radiation Oncology Denial Management

Posted by Robert Lynch on Feb 6, 2018 4:49:50 PM

Working denials in radiation oncology used to be a matter of sorting and looking for the Pareto results (i.e. 80% of your denial volume comes from 20% of your claims).  Practices that were trying to establish priorities in denial management would evaluate denials by dollars and by volume. Inevitably, certain denials by procedure or by payer would be identified, and the group would work on resolving those denials.  The overall process improvement concept would be that as the denial management group made progress they could work their way through to lower value claims and volumes.  The process involved constantly sorting through denials in new ways trying to identify the greatest opportunities.

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Topics: Radiation Oncology Billing

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