Due to constant advancements in medical technology and healthcare regulations, the oncology industry is dynamic and fast-changing. Revenue Cycle Inc. wants to keep clients on the leading edge of what's happening, so we maintain this area of the website as a "clearinghouse" for information about oncology news, CPT codes, and general oncology coding information. Whether it's a legal change that could affect our industry or just an opportunity to pass along oncology coding information, you'll find it here.
If you want more information about how our team of expert consultants can help your practice stay up-to-date with these industry changes, visit our medical and radiation oncology service page.
May 2013 Medical Oncology Coding Tip (View More Coding Tips and News Alerts)
LCD...The Other Definition
For most, outside of the healthcare industry, LCD is defined as “liquid-crystal display.” Consumers typically use this term to describe our TV screens, types of lights, etc.; however, there is another important definition behind the term LCD!
A Local Coverage Determination (LCD) provides the most current Medicare guidelines relating to coverage information for many procedures provided in the healthcare industry, including radiation oncology and chemotherapy procedures.
Contained within LCDs are references of specific CPT® codes and coverage guidelines for different diagnoses. Additionally, LCDs provide guidelines for healthcare providers indicating required documentation to support a service/procedure, information related to provision of services, medical necessity guidelines, appendices and any revision history explanations.
Access to the most current updated LCDs is important as changes to utilization or coverage are unscheduled and implementation of new policies can happen at any given time. It is imperative a provider have an active process in place to review, distribute and implement when changes occur to LCDs. Some suggestions would be performing a monthly review of the current LCDs, sign up for List Serve emails and review payor newsletters to stay current and informed. Access to any LCD can be found and navigated on the Medicare website at www.cms.gov.
As a reminder, ensuring specific payor guidelines are applied is an important step within a documentation and billing compliance plan. Through staff education, proper documentation and effective checks and balance, compliance goals can be achieved.
Revenue Cycle Inc. can assist with implementing processes towards attaining compliance goals. For more information regarding consulting services provided by Revenue Cycle Inc., please contact us by calling 512.583.2000 and request to speak with one of our consultants.
April 2013 Medical Oncology Coding Tip (View More Coding Tips and News Alerts)
Managing Days Sales Outstanding (DSO)
A key metric monitored to attest to financial performance of a practice is referred to as Days Sales Outstanding (DSO). The definition of Days Sales Outstanding (DSO) is the average number of days to collect on a service provided. The higher a provider’s DSO, the more working capital is required to run the business. The same goes for a lesser DSO as less working capital is required to run the business. The more the practice understands what a DSO is, the work involved in managing the metric and how the appropriate revenue cycle approach impacts the DSO, the sooner the practice generates cash.
There are two types of DSO calculations:
The first and most important step to managing DSO is fully understanding what a DSO is and in which direction the number is heading. If the DSO is higher than the predefined benchmark and trending upward, managers need to begin asking questions. A primary question mangers may ask themselves is, “Are we aggressive in collecting the outstanding receivables and could we collect quicker?”
In attempting to answer the above-mentioned question, it is important for a manager to review the financial counseling program and payment terms offered to patients. Creating a written policy that allows the financial counselor to assess the patient’s ability to pay and includes precise terms offered to the patient is the first step in collecting the receivables effectively and achieving amicable arrangements. Also, consider strategies for things such as offering prompt pay discounts. An example would be 10/30 net 60, which means customers will receive a 10% discount if they pay their bill within the first 30 days and no discount if they do not pay within 60 days. Sometimes offering a small discount can help a practice to collect, which in turn lowers the practice’s DSO.
Another factor to consider in limiting DSO is to ensure your processes allow for identification of off-label drugs and/or treatment regimens prior to treatment. Verification of the patient’s insurance policies pursuant to the actual treatment regimen is key. Identify if prior authorizations or predeterminations are required for claim submission while keeping in mind that these are not a guarantee of payment, rather claims will not be considered at all if these are not obtained prior to treatment. The lack of both of these processes has proven to drastically inflate DSO and can be eliminated with exceptional financial counseling and intake processes.
As a reminder, ensuring specific payor guidelines are applied is an important step within a financial counseling program. Through staff education, proper communication, checks and balances, financial counseling goals can be achieved. Revenue Cycle Inc. can assist with implementing processes towards attaining an effective financial counseling program. For more information regarding Revenue Cycle Inc.’s services, please contact our consulting team at 512-583-2000.
March 2013 Medical Oncology Coding Tip (View More Coding Tips and News Alerts)
Review of New Drugs/New Indications
Throughout the year, the Food and Drug Administration (FDA) reviews new drug data submitted by pharmaceutical manufactures and research entities. Upon completion of intensive review, the FDA grants labeling changes to existing approved drugs, adds new indications for use, initiates an accelerated approval, proceeds with regular approval or will decide more information is required from related research entities prior to granting approval for use in humans.
It is important for practices to remain current regarding these additions and potential changes to ensure impacts to your practice are addressed. Areas such as updating a charge master to include new drugs to be utilized by your physicians, ensuring any potential education required for staff in regards to billing or providing the new substances can be provided and implementing proactive approaches regarding reimbursement efforts such as financial counseling.
The following is a partial reference list of Hematology and Oncology drugs for CY2012, which includes FDA, approved new drugs and/or new indications of existing drugs for use in the cancer setting. As noted, many of the approval dates occurred in the last quarter of 2012.
These medications with associated manufacturer, routes of administration and links to additional information may be located on the FDA website by clicking here.
It is important to ensure information such as the drug changes and additions provided above are examined closely. It is recommended to implement processes within a practice for monitoring this information and making changes as necessary. As a full service oncology consulting firm, Revenue Cycle Inc. can assist with development of policies and processes in this area. For more information regarding Revenue Cycle Inc.’s services, please contact our consulting team at 512-583-2000.