Prevent medical billing claim denials in Oncology Practice in 2018

1
(No Transcript)
2
Prevent medical billing claim denials in
Oncology Practice in 2018
Medical billing is seeing a new string of changes
in regulating the medical billing and coding of
the procedures and diagnostic. In 2017,
different medical challenges were faced by
various specialties with the foremost one being
the shift of Medicare towards quality-based
programs. This included Ambulatory surgical
center facing the flank from the insurance
company and patients. One of the major changes we
saw was an increase in medical billing denials
from private insurance companies which let too
long appeals from the doctors. The number of AR
days has increased from average 20 days to 24.5
days- this includes the payment from both the
insurance company and individuals. Before we
understand how different factors would be
affecting the oncology practice billing for 2018
we need to understand different changes for the
year 2017 and how they have affected us MACRA
Changes Medicare Access and CHIP
Reauthorization Act saw a unique mechanism to be
put for the quality check and improve the medical
care. This led to an incentive-based payment
system by forming an advanced alternative payment
model. The model was set to structure different
MIPS quality measures which will help to provide
better medical care towards the patient
population with efficiency and quality care.
MACRA was one of the first to put in rules which
laid the foundation of incentivized payment on
the quality of patient care and outcomes. Many
doctors have even guessed that this would start
when we would be seeing the phase-out of fee for
service.
3
Prevent medical billing claim denials in
Oncology Practice in 2018
Entry of new codes Medicare implemented a 3
tier evaluation code and 1 new reevaluation code
this was laid out in 2017 with CPT manual. All
the new code have been evaluated and added to the
list of always. This also brings a lot of stress
on different evaluation and improvement
techniques for the coding of the bills.
Post-Acute Reform Post-Acute reform is
important to improve the Medicare Post-acute acre
transformation act this continues to serve the
purpose of moving forward and implementing
different quality measures and data collection
requirement. Oncology billing facing an uphill
task None of this is astounding. In numerous
regards, it is an outcome of the expanding costs
and the powerful money related edges related with
oncology practice.
4
Prevent medical billing claim denials in
Oncology Practice in 2018

• For instance, the rate of securing of private
  oncology hones by healing facility frameworks is
  higher than for most different subspecialties. In
  spite of the fact that this may, to a limited
  extent, reflect expanded rivalry for patients,
  the high incomes produced by oncology rehearses
  are probably going to be another driver of this
  pattern.
• Increasing expenses are at the core of the
  expanding weight of earlier approval, disavowals
  and distributed audits, which are presently a
  normal piece of oncology rehearse. The effect of
  these issues for oncologists and for patients is
  winding up more obvious.
• How to prevent Oncology Billing Denials?
• Patient Care and Billing management have to be
  different things when it comes to cancer care.
  The complexity of each patient and the need for a
  billing company is imperatively felt during such
  stage.
• Here are five things you should analyze in your
  oncology billing
• Payers
• Competition

5
Prevent medical billing claim denials in
Oncology Practice in 2018

• Staffing
• Clinical Research
• Electronic Health Records
• Oncology billing is difficult and what makes it
  more difficult is regulation and coding. Payers
  and competition hold the first and second spot
  because they tend to have more effect on revenue
  generation. Payers form a wheel of your practice
  and completion the stones on the road. Staffing
  cost in one of the reasons why most oncologist
  today prefer to start with hospital or group.
  Clinical Research and EHR are part of your
  billing and development process through a part of
  this can be outsourced to a medical billing
  company.