New Bedford Blog: Improve Your Revenue Cycle Management

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

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. 

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:

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.

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.

Understanding how your billing services affect patient satisfaction is critical to the success of your practice.  As patients become increasingly empowered to make healthcare decisions — and increasingly responsible for paying the bill — hospitals and practices must ensure a positive billing experience. Patient experience and satisfaction is the number-one priority for healthcare executives, and a recent study shows that a positive billing experience leads to a higher likelihood that a patient will pay his or her bill or refer a friend to a provider.

What are the Physician Supervision Levels?

Your Radiation Oncology Coder Needs to Decide:  Simple, Intermediate, or Complex?

ASTRO’s Nine Elements of Clinical Treatment Planning Documentation for Optimum Coding