Oncology practices handle some of the most complicated environments in healthcare reimbursement. From billing chemotherapy drugs, infusion coding, prior authorizations, payer compliance, and every step in the revenue cycle, precision is required in all areas. As a result, oncology practices and specialty clinics are beginning to utilize full-service oncology revenue cycle outsourcing to enhance collections, lower denials, and increase their financial health.

The Specifics of Revenue Cycle Management in Oncology

When compared to general medical practices, the complexity of oncology practices is a step higher due to the involvement of high cost medications, intricate treatment regimens, prior authorizations, and changing policies from payers. Even the smallest of coding errors can lead to revenue loss. Oncology specific, full service RCM Services for Healthcare ensure billing and documentation compliance with payer policies.

Outsourcing provides a means of partnering with individuals specialized in chemotherapy administration coding, drug wastage reporting, the application of modifiers, and value-based reimbursement. This specialty approach enables oncology practices to stay compliant while also increasing their reimbursement rates.

What Oncology Revenue Cycle Management Offers

Full-service oncology RCM Services for Healthcare encompasses the entire revenue cycle, including:

1. Registration and eligibility verification

Correct entry of patient demographics and the real-time verification of insurance readily avails previously denied claims and errors. This also enhances financial transparency for the patient.

2. Handling Prior Authorizations 

As most oncology treatments require multiple prior authorizations, our external teams handle documentation, submission, follow up, and anything else that prevents delays in treatment or reimbursements.

3. Medical Coding and Charge Capture 

Our certified oncology coders are trained in proper CPT, HCPCS, and ICD-10 coding associated with chemotherapy, radiation therapy, and immunotherapy, and associated services. Clean coding is imperative for clean claims submission.

4. Claims Submission and Posting Payments 

Prompt electronic submission of claims and accurate posting of payments submitted boosts cash flow. Denied claims are reported and resolved in a timely manner.

5. Appeals and Denial Management 

Our specialized teams analyze the reasons for denial, make the necessary corrections, and resubmit the claims. This is the most direct and efficient way to reduce days in the accounts receivable and to increase net collections.

6. Follow up in Accounts Receivable  (AR) 

Determined collection efforts towards payers has a direct impact on the resolution of claims that have not been paid or that have been paid at amounts lower than anticipated.

7. Reporting and  Compliance 

Compliance audits, KPI tracking, and financial reporting ensure adherence to the guidelines and laws impacting the organization.

Benefits of Outsourcing Oncology RCM

Enhanced Cash Flow

Dedicated teams improve the revenue cycle and reduce the time until the organization receives its reimbursement.

Decreased Administrative Burden

Outsourcing RCM Services for Providers allows oncology practices to make the best use of their clinical staff by allowing them to concentrate on patient care rather than administrative duties.

Cost Savings

With an in-house billing department you need to factor in employee recruitment and training, possible need for new software, and ongoing staff oversight for compliance. Outsourcing billing departments can reduce all these overhead costs and provide access to in-house specialists.  

Improved Compliance and Accuracy

Billing compliance in oncology is incredibly complex and frequently changes. Experienced Healthcare RCM Services has the most up to date knowledge of compliance and are able to decrease the risk for the oncology billing practice.  

Better Analytics and Technology

The modern RCM partners utilize automation, advanced analytics, and innovative AI technologies to more accurately identify billing trends, predict and thwart billing denials, and better aid in revenue forecasting.

The Right Oncology RCM Partner

The oncology billing RCM partner should have a proven history of experience in oncology billing, low denial rates, good reporting/denial transparency, good HIPAA compliance, and good growth (scalability). The best partner will be able to offer several options for RCM Services for Healthcare that are customized to your practice.

Final Thoughts

RCM Services for Providers offers oncology practices opportunities to optimize revenue cycle management, ensure compliance, and provide the best care possible to their patients. In order to keep up with changes in RCM Services for Providers, revenue cycle management must be improved, driving oncology practices to invest in RCM Services for Providers. Investing in oncology practices focuses on revenue cycle management and the care provided to the patient and drives long-term revenue fundamentals for oncology practices.