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
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.
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 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.
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
- 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.