Oncology Billing ServicesPractice ManagementRevenue Cycle Management (RCM)

How Hospitals Can Bill For Outpatient Cancer Care?

Hospital medical billing and coding partners for outpatient cancer care centers deliver knowledge from multiple sides of the medical and radiation oncology industry. They are the experts in both, the clinical and business aspects of revenue cycle management.

Their unique know-how at the business level, along with the background of working in the outpatient cancer care center and management, is invaluable. And when you combine their practical, real-world experience in cancer patient medical billing services with action-driven results it’s clear that that billing personnel are well-suited to turning your progressive practice into profit shelling center.

Insights On Medical Billing For Outpatient Cancer Care Center

The latest research report published in the American Journal of Managed Care highlights the need for fair and transparent pricing of cancer-related hospital services to protect patients from erratic financial burdens at a time when they are most susceptible. These are the finds of the researchers who conducted the analysis.

Martin Makary, M.D., M.P.H., a cancer surgeon and professor of health policy at the Johns Hopkins University School of Medicine, and also one of the senior authors of the research report, is of the view that “unjustified price markups contribute to the steep rise of health insurance and out-of-pocket costs to patients. We found that some outpatient cancer centers bill and code fairly, while others engage in pricing malpractices of insurers, patients and their employers. Hospital alterations in quality or charity care do not account for these dramatic price differences.”

For the research, Makary and his teammates attained all the medical billing records of approximately 3500 hospitals from all 50 states in 2014 to define how much hospital and their various units that offer cancer-related outpatient services billed for services compared with the Medicare allowable amount. This is a set amount that Medicare will pay for specific procedures given.

Utilizing the American Hospital Association database, the exploration team identified scope, nonprofit status, countryside location and academic status for each hospital, which’s billing data, was the base of the analysis. The study team also found out that a subgroup of prominent hospitals that were listed among the U.S. News & World Report’s Best Hospitals Honor Roll for 2014.

Numbers Game That Defines The Outpatient Cancer Care Medical Billing

For each cancer care specialty service within the hospital, the experts calculated a markup ratio and defined the ratio of the charges billed relative to the Medicare allowable amount.

For example, a markup ratio of 3.0 which means that for a procedure with a Medicare allowable amount of $1,000, the hospital charged $ 3000 or 200 percent above the Medicare allowable amount. The services given included lab tests, chemo infusion, radiation services, and PET scans.

Further breaking down the numbers the research team found that of the 3500 hospitals, specialty cancer departments charged anywhere between 2.4 and 4.1 times more than what Medicare reimbursed for those procedures.

To present you with some forecasting number from the research report: radiology specialty treating cancer patients charged in an excess of 3.7x more for services; oncology had 2.3x to 2.4x more, while pathology outpatient care centers charged 4.1x more.

We as specialty medical billing companies feel that cancer patients who already are going through so much trauma shouldn’t be put into such a bankruptcy-like situation only because a hospital bloats a bill well above what a healthcare payer would pay for the exact same service.

However, now things are changing and some states have taken up the legislation aimed at protecting patients from collection agencies that hold patients responsible for the portion of the charges that is in excess of what the highest payer company would pay.

While Medicare is not the golden standard, it’s a benchmark of the varying degrees of price fluctuations occurring in the healthcare market. What we need is more price transparency to end the most rigorous price extorting practices and ensure that outpatient cancer centers fulfill their moral duty and end their money extracting practices.

In the US, the cost of cancer care is anywhere between $40,000 and $400,000, this depending on the type of procedures rendered and their local markup rates.


Medical Billers and Coders

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

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