New Bedford Blog: Improve Your Revenue Cycle Management

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.

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

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.

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.

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.

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.

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.

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. 

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:

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).