Radiation Oncology Pay Freeze

On December 28th President Obama signed the Patient Access and Medicare Protection Act. The big headline grabber from this law has been the Meaningful Use Hardship Legislation, which expands eligibility for hardship exemptions for Stage 2.

Bigger news for Freestanding Radiation Oncology Centers is found when digging a little deeper into bill S.2425: Payment for treatment delivery and image guidance codes in 2017 and 2018 will remain at the same levels set for 2016.  

This law removes the looming threat of removing the vault as a direct expense when calculating reimbursement, as well as increases in equipment utilization rates, which would have lead to major reductions in payment.  Radiation Oncologist can rest easy knowing that reimbursement will remain steady, at least for a few years.  The Bill also sets 2019 as the target for a transition to an episodic alternative payment model.

Medicare Announces Delayed Decision on Vaults and New Codes Until 2016

Yell hallelujah, hell yeah or wahoo, whatever your chosen exclamation might be because Medicare just made your month!  The Centers for Medicare and Medicaid Services (CMS) have granted the wishes of everyone in the radiation oncology industry with their release of the final 2015 Medicare Physician Fee Schedule.

The decision not to remove the cost of the vault as a direct practice expense when calculating reimbursement rates for 2015 is a money saving (read: life saving) move for radiation oncologists. Additionally, CMS has decided to continue to pay for some of the eliminated treatment codes from 2014. They will do this by creating g-codes for those eliminated codes and continuing to reimburse physicians at the same, previous rate.

These two updates will result in a 0% reduction for radiation oncology providers, which is great news compared to the 8% reduction rate we were facing!

So who is to blame for those celebratory high-fives you’re all giving right about now? We can all give a huge thanks the American Society for Radiation Oncology (ASTRO) as they led an advocacy campaign designed to keep the payment cuts CMS proposed in July from going through.  Over 160 bipartisan members of Congress, along with several radiation oncology industry stakeholders, wrote letters to CMS discussing the impact of the reimbursement cuts, begging them to reconsider. Thankfully these efforts did not go without notice and the MPFS final rule states that CMS will be delaying its decision regarding these hot button issues for one more year.

In addition to this, CMS released their 2015 Hospital Outpatient Prospective Payment System (HOPPS) final rule, though this week they will be issuing the final rules, so stay tuned!

Medical Billing Questions to Ask - Radiation Oncology

Are you asking yourself the right questions?

Revenue cycle management can be a cumbersome component of running your practice and managers often become so comfortable with current protocols that they don’t recognize how industry changes are impacting their business.  Once it becomes apparent that something needs to be done to improve collections, where do you start? The questions and concerns can become overwhelming, but the worst thing you can do is avoid change and remain at a standstill. How are practices supposed to know what questions to ask themselves and the companies they are considering outsourcing to?

We sat down with Universal Health Network’s (UHN) CEO Peter Wall last week at ASTRO 2014 in San Francisco and discussed the questions he advises potential new clients to ask themselves.

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• With extensive coding changes on the horizon, who is going to train your staff?
• How much will that training cost you?
• How much time will that training take up?
• Who is acting on your behalf with local representatives to fight increased reimbursement cuts proposed by CMS?
• How will you make up for the revenue lost with these inevitable cuts?
• How do you measure and improve the efficiency of your revenue cycle management process?
• Can your billing protocols be simplified?
• How much money each month could you be losing due to ineffective processes?
• If you decide to outsource, how will the cash flow transition work?
• Do you have anyone fostering relationships with payers across the board? Ex: Insurance Providers, Medicare, Medicaid etc.
• Can you provide cost estimates for all kinds of payers if a patient requests it?
• What is your biggest fear regarding outsourcing your billing?  Is it fear of the unknown, fear of losing control or fear of wasted revenue?

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Coding changes and reimbursement cuts account for just the first round of adjustments radiation oncology practices and organizations will need to make in order to remain successful.  The team at UHN has been working to stay ahead of the curve in regards to industry changes, urging practices to see that they can do better. 

Wall commented saying, “We tell our clients, don’t settle for your current income. Don’t you want to be making more? You could be collecting up to $10,000 more each month, we want to help make that happen.”

UHN’s goal is to be a resource powerhouse for radiation oncology practices, giving them the tools to increase revenue and improve their processes. To discuss the customized answers to the aforementioned questions that UHN can provide to your practice, simply fill out the form below.