Radiation Business Solutions creates value for oncology programs, while creating a better financial experience for cancer patients. Since 2004, we’ve provided oncology-specific strategies to physicians and hospital based programs, including total revenue cycle management, patient experience programs, referral optimization services, and new cancer center development.
By Mandy Pewitt, Director of Analytics and Information Technology
2017 is ticking away and there are less than two months remaining in this first year of the MIPS Quality program. While the incentives this year will not be substantial, failure to report Quality measures can reduce your Medicare reimbursement in 2019 by up to 4%. For example, if your group generates $200,000 in revenue each month with Medicare payments comprising 50% of your payment mix, you could stand to lose as much as $48,000 in 2019!
Here are a few highlights of the MIPS Quality program which has three initiatives in which your participation/or non-participation will affect your ability to avoid the penalties or earn an incentive:
Quality Reporting (60%/85% of the composite score)
- In order to avoid a penalty and potentially earn an incentive in 2019, you may report on 2017 dates of service as an individual using the ASTRO MIPS Wizard (similar to the ASTRO PQRS Wizard) by March 31, 2018. Reporting this year will include four radiation oncology-specific measures which are the same measures that were used in the past for PQRS. However, this year you must report for 50% of all patients who were seen (regardless of insurance payer) within a 90-day period. Your billing company should be able to provide you with the reports you need to enter your information.
Improvement Activities (15% of the composite score)
- ASTRO offers both the RO-ILS and APEx programs to meet this MIPS objective which comprises 15% of the composite score. Participation in these programs requires planning by your practice to choose a 90-day reporting period and to determine which measures are achievable. Start planning ahead now for 2018 reporting. For your information the cost of completing an APEx certification through ASTRO is $14,000. There are no costs associated with the participation and utilization of the RO-ILS. If you are affiliated with a hospital-based provider, it would require the cooperation with the hospital-owned facility to invest in either APEx or the RO-ILS.
Advancing Care (N/A for hospital-based providers)
- Any Radiation Oncologist who performs 75% of services within a hospital setting it now exempt from the Advancing Care (formerly known as Meaningful Use) portion of MIPS. If you are exempt, your Quality reporting will have a greater impact (85%) on the composite score that determines the incentive you will receive in 2019.
- Hardship exemptions are available for those in free-standing centers to earn an exemption for Advancing Care reporting.
Still confused? Radiation Business Solutions is providing guidance to our clients to assist in navigating the MIPS program. We are also available on a consulting basis to help practices with the actual reporting process. Contact us to learn more!
The Key to Successful Point of Service Collections
By Carolyn White, Patient Account Liaison
Point of service collections is becoming more and more important with the rise of high deductible health plans. The key is information. Before a patient comes into the office for their initial consultation, it’s important to know the patient’s responsibility and to make an effort to collect that day. Even if you work in a small practice seeing 100 office visits per month with an average co-pay of $30, that adds up to $36,000 annually!
All patients should have their coverage verified with detailed benefits for your specialty, and note whether or not referrals or authorizations are required. Once a treatment plan is determined by the physician an estimate can be given to patient and a payment plan can be offered if needed. Some patients will be fully covered, but may not be aware. It alleviates stress and anxiety for the patient to have this information upfront.
Depending on the overall health of your patient demographic they may be getting lots of different bills, and they may be unsure of which bill is for what service and whether or not they owe it. By having this work done proactively you can eliminate the confusion and the financial toxicity that comes with expensive medical procedures.
We Are Grateful
Each year, our cancer centers hold a special event in honor of their referring physicians. Our gratitude luncheons are now quite well known as “don’t miss events” in our markets! In addition to great food and fellowship, each center also combines the event with a canned food drive for their local food bank.
While each center puts their own spin on things, the purpose is the same: to show our appreciation to the medical providers, and to help give back a little bit to the communities we serve.
Connect us with an oncology program that wants to grow! We’ll pay a $10,000 referral bonus for new clients that enter a contract with us for billing services, Market Track referral optimization program, or a Revenue Navigator program. For more information contact us at Info@RadiationBusiness.com or call 615-746-1705.