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Revenue Cycle Management Survey – What Does it Mean for your Practice?

Black Book Market Research annually evaluates leading service providers across 18 operational excellence key performance indicators completely from the perspective of the client experience. In a 2017 survey of Finance and Revenue Cycle Management they covered a variety of topics including patient payment solutions, patient accounting and patient management, complex claims solutions and patient access, to name a few.

Core Elements in Your Payer Contracts

Adequate and timely reimbursements are essential to an independent medical practice. Practices’ operational leaders should create and maintain a spreadsheet master for their top five or six major payers. Reviewing and understanding the complex components of each contract is crucial to avoiding claim denials and offering comprehensive (and reimbursable) services to patients.

CMS Looks at Over- and Underpayments

Each year, the Centers for Medicare & Medicaid Services (CMS) calculates the Medicare Fee-for-Service (FFS) improper payment rate through a program called Comprehensive Error Rate Testing (CERT). Because of this program, CMS has been able to decrease its error rate.

Advanced Analytics are Vital to an In-Office Dispensing Program’s Success

ION Solutions’ Specialty Oncology Network (SON) pharmacy and dispensing program was developed to help community oncology practices capture additional revenue from filling oral oncology prescriptions. The advanced analytics available through the SON make it easy for practices to measure performance and optimize patient care. One tool, Smart Rx Analyzer, provides a dynamic view of a practice’s dispenses so staff can quickly detect patterns and take steps to improve clinical operations and efficiencies.

Reimbursement of Biosimilars without Q Codes

The future of drugs is biosimilars, as controlling costs has long been a focus of the Centers for Medicare & Medicaid Services (CMS) and private payers. While generic drugs are identical to their branded counterpart, biosimilars are a biological product that is highly similar to its reference product, notwithstanding the minor differences in its clinically inactive components. Given the complexity of how biosimilars are grown (complex living systems vs. chemical synthetization in generics), it is unlikely for biosimilars to be exact replicas of the original.

Addressing Your Office Procedures to Combat the Perception of Fraud

The Fraud Prevention System (FPS), implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011, uses models that predict suspicious behavior with the goal of preventing the payment of fraudulent claims. This system has saved the federal government millions of dollars. 

NOC Claims and Ensuring Your Practice is Reimbursed

When there is a new drug or procedure that comes to market, it typically takes the Centers for Medicare & Medicaid Services (CMS) about six months to evaluate it and determine a reimbursement rate. During that time period (sometimes up to a year), practices can start billing under a Not Otherwise Classified (NOC), Unspecified or Miscellaneous Code.

USP 800 and the Effect on Oncology Practices

To protect patients and healthcare workers from potential harm, US Pharmacopeia (USP) Convention’s General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings was developed to help ensure the safe handling of hazardous drugs throughout the healthcare system. These new regulations could mean significant capital expenditures and practice process changes for those who administer chemotherapy drugs.

Understanding Your Practice’s Responsibility with OIG Excluded Providers

As healthcare costs continue to increase, CMS has employed more agencies to conduct investigations to find improper payments through either fraud, waste or abuse. The OIG maintains a list of healthcare providers who are excluded from participating in Medicare, Medicaid and all other federal health care programs. The database includes a variety of healthcare providers, not just physicians.

Best Practices for Early Adoption of Treatments

With so many new drugs on the market, there are some challenges to getting reimbursement. Practices may not be early adopters of these drugs as there may be initial claim denials if not billed appropriately. Claims submitted electronically without the required information often create the denial which in turn adds additional administrative costs on the practice and increases days in AR. In addition, reimbursement may be less than your cost if you are unaware of your contracts and bill incorrectly, placing additional risk on the practice.

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