Top 4 Trends Affecting Radiation Oncology Billing Practices

April 19, 2021 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Radiation Oncology

Radiation oncology practices

As the medical billing process continues to change and evolve, so has radiation oncology billing. With more advances in medical technology and continuous changes to medical billing procedures, radiation oncology has also been forced to adapt along with other specialties. 

Not complying with these current trends in radiation oncology can result in a difficult reimbursement process, which also takes away your time from caring for patients. For superior and streamlined radiation oncology billing, follow these medical billing tips and trends - and effectively boost your revenue cycle management in the process! 

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What is Radiation Oncology?

Also known as radiotherapy or radiation treatment, radiation oncology is a medical specialty that focuses on cancer treatment. Radiation oncology works by using high-energy radiation to target and damage the DNA of cancer cells, destroying their ability to divide and continue to spread. More than half of all cancer patients are treated with some kind of radiotherapy during treatments. 

This treatment can be delivered to the patent in one of two ways: through machines called linear accelerators or through radioactive sources placed inside the patient. While radiation oncology encompasses curing cancer, the specialty may also include treatments to alleviate the patient’s pain and other symptoms.

Radiation Oncology Industry Outlook

With ongoing advancements in medical technology, the radiation oncology industry continues to expand. The radiation oncology market size in the U.S. alone is expected to reach $3.9 billion by 2027, with a compound annual growth rate (CAGR) of 5.0%. With the advent of newer therapies and technology advancements, radiation oncology is trending to be more effective and efficient, leading to further market expansion. 

Besides progress with radiotherapy technology, increases in cancer prevalence are leading to the expanded market size. Global cancer cases are expected to grow to over 27 million new cases by 2040, increasing alongside growth in the aging population. This growth of cancer prevalence has led to greater market demand for radiation oncology practices and market expansion. 

Trends in the radiation oncology industry

4 Top Trends In Radiation Oncology Billing

With the medical landscape constantly shifting, here are some of the current trends in radiation oncology that may affect billing. 

Medicare 2022 Adjustments 

The Centers for Medicare and Medicaid Services (CMS) announced that there will be significant cuts in the reimbursement value of radiation oncology and other specialties. These changes, originally planned for January 2021, have been delayed to January 2022 and will present significant financial challenges for radiation oncology practices moving forward. The expected impact is an estimated 5% decrease rate for radiation oncologists. With these changes, your radiation oncology billing should be as efficient and streamlined more than ever to ensure a steady flow of revenue not lost to denials. As of now, CMS plans to provide additional information on the delayed implementation.

Shift to Value-Based Payment

The landscape of the healthcare industry as a whole is shifting closer to a whole performance and quality-based future. As a result, radiation oncology billing and reimbursement will be increasingly based on quality of care rather than operating with a fee-for-service model. As a result, gone are the days that a medical practice was deemed successful by the size of its patient base; instead, the responsibility is on practices to assume an appropriate level of financial risk for the care and treatment for patients, making “fiscal stewardship” essential for success in the emerging value-first medical economy. To succeed in this value-first medical economy, radiation oncologists must evaluate their medical billing process to spend more time with patients and less on the operation requirements of their practice. 

Adoption of ACOs

For practices following the value-based care movement, many are starting to participate in the  Accountable Care Organization (ACO). Over the last few years, ACO healthcare networks are becoming a more common fixture in the current medical landscape. 

The Centers for Medicare & Medicaid Services (CMS) defines ACOs as groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated, high-quality care to their patients. With ACOs, patients, especially the chronically ill, get the right care at the right time without enduring medical errors or duplicative treatments, visits, and services. Many radiation oncology practices that are adopting value-based care systems are becoming involved with an ACO to ensure the most efficient care to their Medicare patients and are following compliance standards. 

Outsourcing Medical Billing

One of the more common challenges with radiation oncology practices is receiving timely reimbursements. Incorrect coding and even minor errors can result in difficulty receiving payments. By outsourcing medical billing, radiation oncologists can effectively boost their revenue cycle management and expect cleaner and faster claims processing. As billing regulations continue to model the medical billing world, more radiation oncologists will continue to depend on expert outsourcing for their radiation oncology billing needs. 

Medical Billing Tips for Radiation Oncology Practices

Medical billing tips for radiation oncologists

For the most efficient radiation oncology billing possible, follow these best practices for a streamlined process:

Consistently Update Patient Records 

For the most efficient medical billing experience, radiation oncology practices need to constantly update patient records. This includes verifying the insurance coverage of your established patients at every visit. A common issue with insurance companies and the reason for denied claims is outdated patient records, including ineligible insurance coverage. Consistently verifying patient records can reduce the chance of any disruptions to and prevent denials and delays from terminated coverage, services not authorized, services not covered by the plan, or maximum benefits reached.

Conduct Regular Medical Billing Audits

To help ensure all your patient charts and records are as accurate and organized as possible, your radiation oncology practice should conduct regular medical billing audits. An audit combs through all your present patient data and records to identify, monitor, and correct any inaccurate, incomplete, or inappropriate billing practices, as well as review that all information is up to date. 

Ensure Accuracy in your Claims

Most denials and delays with reimbursements are due to incorrect data or missing information on claims. Reports have found that as much as $8.6 billion is lost per year in appeals-related administrative costs are due to errors in medical billing alone. To avoid inaccuracies, ensure there’s a second set of eyes reviewing each paper or electronic claim to your office files to ensure the required fields are completed.

If you’re only using electronic claims, check that your software system flags users to review missing fields and input all required info before allowing them to submit to ensure the most accurate claim submittals. These extra steps ensure accurate billing for streamlined reimbursement. 

Identify the Why In Your Medical Claim Denials

If your radiation oncology billing runs into obstacles, it’s important to understand why your claims are being denied to fix the problem. This includes reviewing all of your denial notices from a set period of time, such as three or six months, and logging the associated reasons for the denial. 

For claims denied due to registration issues (insurance verification, incorrect payer, cannot identify patient) or charge entry (invalid or incorrect procedure or diagnosis codes), your practice can trace back to the party responsible. First look for patterns and then talk it out with the staff members who are repeat offenders.

Choose An Expert Outsourced Medical Billing Company

Outsourcing your medical billing process to a trusted third party allows for your practice to focus on developing care for your patients while you can trust that your radiation oncology billing is being handled by experts. With experience in both hospital and private practice radiation oncology, our team can effectively empower your radiotherapy practice and boost your overall revenue cycle management. To learn more about how NCG Medical can transform your radiation oncology billing for success, contact us today.

Contact a Radiation Oncology Billing Expert

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