Medical billing industry has been constantly changing and evolving. New regulations and technologies completely transformed the manner in which the medical billing was performed. In recent years, oncology billing has fallen prey to the new medical billing procedures, and requires the practice to comply with certain medical trends. There are several reasons that affect oncology billing, some of which are:
The new ICD-10
On October 1st 2015, the 10th revision of International Statistical Classification of Diseases, commonly known as ICD-10, came into existence. It replaced the ICD-9 codes and contains 71,924 procedure coder, as well as 69,823 diagnosis codes. Medical coders were forced to learn these new coders which resulted in poor productivity and workflow of many medical billers.
The foundation of ICD-10 disclosed the inefficiency of many oncology practices and induced them to outsource their medical billing and coding inorder to completely comply with the new regulations. Outsourcing Oncology billing has made it easier for them to place their attention on patient care rather than on ICD-10 implementation and adaptation.
ACO's
A voluntary group, Accountable care organization (ACO), is a group of healthcare providers that work together to provide efficient care to their Medicare patients. The main objective of this group is to make sure that the patients receive the right type of care at the right time preventing errors and service duplications.
Oncologists involved with an ACO, must make sure they are meeting compliance standards and have taken advantage of outsourcing oncology billing.
EHR
Many Oncology facilities have started using the Electronic health records (EHR) for their practice, while some are still lacking in billing integration. EHR that comprise of billing integration helps the physician get paid in a timely and efficient manner.
They eliminate huge time required to fill out forms inorder to collect payment. For this administrative burden, oncologist prefers outsourcing their oncology billing chores.
The Affordable care Act
On March 23, 2010, the Affordable Care Act was introduced with an intention to make medical care accessible to all, including those who previously uninsured. With more people insured come more procedures and more medical coding and billing.
In such cases, accuracy becomes a prime factor for the oncology billing services. ACA has put strict documentation rules in place, so that billers and coders need to be 100% accurate in coding procedures. This has let many practices to turn to outsourcing which leads to reduced denial rates or billing delays, creating an easy and balanced work for physicians, patients, and providers.
Value based payment
Within the next five years, many predict that reimbursement will be based on quality of care, rather than operating a fee-for-service model. Many physicians have showed concern with regards to these new methods.
Oncologists must assess the payers market and evaluate the new billing, coding and documentation process. Inorder to improve the quality of care, physicians will have to spend more time with patients, leaving less time on the operational requirements of their practice.
While you spend more of your time with patients to provide higher-quality care, a dedicated billing team can streamline your transition to value-based payment, maximizing revenue and handling operational tasks such as billing, coding, and documentation.
Considering outsourcing?
As seen above, incorrect coding results in poor patient care and difficulty with reimbursements. Outsourcing the billing duty to a trusted billing and coding company can effectively manage your revenue cycle. Practitioners can expect cleaner, faster claims, backed by superior business process.
Recent estimates suggest the United States currently has 20-30 percent fewer medical coders than needed. Incorporate this shortage with the productivity losses created by ICD-10, and the result is a perfect blend of revenue and lost time, as well as denied claims due to incomplete or inaccurate coding.
As new technology and regulations continue to change the world of medical billing, more and more oncologists will invest in oncology billing solutions from a dependable provider.
FAQs
1. What is ICD-10 and how did it impact oncology billing?
The ICD-10 update (Oct 1, 2015) introduced nearly 140,000 new codes, causing steep learning curves and workflow challenges. Many oncologists outsourced billing to ensure compliance and focus on patient care.
2. How do Accountable Care Organizations (ACOs) influence oncology billing?
Oncologists in ACOs must meet strict documentation and compliance standards, which often leads practices to outsource billing for better accuracy. Ensures timely, efficient reimbursement aligned with quality care.
3. Why is EHR integration important in oncology practices?
Integrated EHR systems with billing modules significantly reduce administrative burden and speed up payments. Practices lacking this often outsource billing to bridge the gap.
4. What effect did the Affordable Care Act (ACA) have on oncology billing?
The ACA increased insured patient populations, leading to higher billing volumes and stricter documentation rules. This drove many oncology practices to outsource billing to reduce denials and delays.
5. How is the shift to value-based payment models changing oncology billing?
Value-based care ties reimbursements to patient outcomes rather than services rendered. Oncologists often rely on outsourced billing teams to manage complex coding and documentation needed for these models.