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

QPP Training For Your Radiation Oncology Practice

Posted by Robert Lynch on Jan 30, 2018 2:22:44 PM

The Centers for Medicare & Medicaid Services (CMS) launched a new data submission system for providers who participate in the Quality Payment Program (QPP). The QPP is composed of two tracks, but in the early years, most providers will participate via the Merit-based Incentive Payment System (MIPS).   MIPS program data submission is comprised of three performance categories: Quality, Advancing Care Information, and Improvement Activities.

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Topics: Radiation Oncology Billing

Survey Reflects Growth in Oncology Prior Authorizations

Posted by Robert Lynch on Jan 23, 2018 7:53:23 PM

A joint survey of the Association of Community Cancer Centers (ACCC) and the Advisory Board Oncology Roundtable confirms a trend in oncology and radiation oncology prior authorization growth that New Bedford reported earlier in the year.  In an October 2017 blog, New Bedford reported that prior authorization requirements had grown approximately 20% to 31% of all courses of treatment in 2017 from approximately 26% of all courses of treatment in 2015.

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Topics: Prior Authorization

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

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