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Radiation Business Solutions Blog

How to Mitigate Proposed CMS Cuts in Radiation Oncology

Radiation Business Solutions - Wednesday, July 22, 2015

Posted by Greg Merrill, President of RBS/RBSE

As most folks in our industry are aware, on July 8, 2015, the Centers for Medicare and Medicaid Services (CMS) issued its annual Medicare physician fee schedule proposed rule that would reduce Medicare payments for radiation oncology services by changing an assumption involving the overall use of linear accelerators, to take effect January 1, 2016. Our experience tells us more often than not that industry reaction may give rise to fear, uncertainty and doubt. However, as time passes beyond the heat of the summer and into the fall, advocacy organizations like ASTRO help garner the support and supply much of the quantitative data that more often than not avert most of the initial magnitude of the proposed rule. This is not to minimize the reality that our specialty has been the recipient of multiple years of modest CMS cuts to this segment of each practice's patient mix. 
 
The team at Radiation Business Solutions, Inc. will be vigilant in its study and monitoring of the progress of the proposed rule as it makes its way toward a Final Rule and fee schedule for 2016. Ultimately we will be able to provide our clients with insight into the specific impact to each practice's revenue stream. In the meantime, the RBS team will continue to execute on the tried and true revenue cycle activities that have proven to maximize the return on each practice's productivity (and often mitigate the effects of CMS reimbursement cuts).  Some of those activities include:

1. A robust communication link between the RBS billing team and each client's practice

2. The rigor of regularly performed Treatment Protocols to identify any missing charges during the course of a patient’s treatment

3. Spending the necessary time on the front-end of a patient’s encounter with our client's practice to obtain required payer authorizations, pre-certifications, etc.  This activity generates an industry leading Low Claim Denial Rate  (Translation: getting payments efficiently for the services provided to patients). 

Finally, one thing to keep in mind about the impact of a focus on incremental patient volume in your market. There is absolutely no better mechanism to off-set the impact of payer reimbursement cuts than the effect of increasing incremental patients to your practice. This is why we dedicate a significant amount of time and energy on executing our in-market business development plan around our RBS Evolution, LLC cancer centers – Peninsula Radiation Oncology Center, Southeast Radiation Oncology Center, and Northeastern Nevada Radiation Oncology Center. This program does generate results if diligently executed with keen physician involvement in outreach.

The bottom line:  the 2016 CMS Proposed Rule may provide some challenges for our industry, but with the right people, processes, and technology on your side, it could just be a minor bump in the road. 

The link to ASTRO’s summary of the 2016 CMS Proposed Rule is https://www.astro.org/Practice-Management/Reimbursement/Medicare/News/2015/Medicare-Physician-Payment-Rule-Poses-Significant-Immediate-and-Long-Term-Challenges-for-Radiation-Oncology.aspx