Manual Prior Authorizations, the Biggest RCM Opportunity

Posted by Robert Lynch on Aug 13, 2018 3:34:00 PM

Who couldn’t use an extra $9.5 billion?  According to CAQH, that is the estimated savings for providers if certain Revenue Cycle Management (RCM) transactions could be automated. What is the transaction with the biggest potential for savings?   Prior authorizations.  According to new data recently released in the fifth annual CAQH Index the total potential savings by automating RCM transaction savings is $11.1 billion, of which $9.5 billion is borne by providers.  Below are the estimated RCM transactions and the differences between the automated and manual costs.

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Topics: Prior Authorization

Virginia General Assembly Improves Credentialing

Posted by Robert Lynch on Aug 7, 2018 11:26:28 AM

Managing provider enrollment applications can be overwhelming. The data collection process can be incredibly fragmented and numerous payers impose unique requirements to create a network of delays. But there are some signs of relief, not only with new cloud-based workflow applications but with new regulations too.

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Topics: Physician Credentialing

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

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