Revenue cycles for oncology practices in the United States are continuing to increase in complexity.
One study published in the Journal of Oncology Practice found that in order to obtain prior authorization for outpatient breast chemotherapy, 17 process steps were required. Furthermore, the same study found that community oncology practices require six staff persons on average to exclusively manage prior authorizations.
This example of the challenges in obtaining prior authorizations is only one piece of the revenue cycle puzzle. Similar examples of management challenges can be found in most other pieces of the revenue cycle as well.
The complexity and challenges oncology practice managers face are quite daunting. Oncology practices are too often forced to choose between high-quality patient care and operational sustainability.
In light of these difficulties, we wanted to share some of the insights that we have found to be particularly helpful in overcoming the problems commonly encountered in revenue cycles.
It is a known fact that payers continue to deny claims despite the best efforts of oncology practice managers. According to a recent article in Healthcare Finance, 33% of hospital executives are reporting average claims denial rates of 10% or more. The level of these denial rates is quite alarming because of the havoc these rates wreak on revenue and profit growth, much less forecasting.
Payers deny claims for a variety of reasons. Some of the more common reasons include coding, medical necessity, and clinical validation. No matter what the reason for denial may be, reducing denial rates for your oncology practice is an excellent way to improve your revenue cycle.
As you have probably experienced in your own practice, many claim denials are entirely preventable. In order to prevent claim denials, you need a practice management partner that understands the ins and outs of oncology practice and its relationship to claim denials. A reliable management partner can put proven systems in place to prevent unnecessary claim denials and dramatically reduce your denial rates.
It’s no secret that payers don’t make the claims process an easy or straightforward one. There are many details to include and proverbial “boxes to check” when it comes to claim submission. Even for the most earnest and diligent oncology practice claims teams, there will still inevitably be error-laden claims.
In order to improve the revenue cycle of your oncology practice, it is critical that you have a systematic process in place to reduce the number of errors in claims. This is another important instance where experience in oncology practice really does matter a great deal. It often starts with knowing the end before the beginning. By partnering with an oncology practice expert, you will know what payers look for and how errors in claims can be prevented. The result is a substantial boost in your clean claim rates.
Accounts receivable teams at oncology practices face a sizable challenge in trying to prevent the number of days in AR from perpetually increasing. Sometimes it can feel like attempts made to shorten days in AR are met with the opposite intended effect due to larger industry forces at work.
In order to truly shrink your average days in AR without reverting back to long delays, you need a team of experienced revenue cycle managers. These managers can put proven processes in place to ensure that your average days in AR decrease and stay there for the long term. The end result of implementing a proven management team and system is increased net collections and revenue.
One of the largest barriers to taking your revenue cycle management practices to the next level is a profound lack of visibility into practice analytics. All too often practice management data is siloed in different systems within the practice. Billing, collections, payroll, taxes, and operational metrics are often housed in isolated systems with very limited ability to see how the different pieces of data relate to one another.
As a management partner that specializes in oncology practice, we provide a 360-degree analytic picture of how each piece of your practice works together. For example, by understanding the relationship that billing, collections, and profit share, you are better positioned to make key decisions in optimizing the revenue and profit growth for your oncology practice.
Not all claims are the same in terms of the level of complexity. There are some claims that are simply more straightforward and, therefore, less error-prone. These claims also typically take less time to generate resulting in fewer staff members needed.
On the other hand, there are some claims that are far more complex. These claims can be laden with landmines and pitfalls that are ripe for errors despite the best efforts of claim team members.
You can make a positive impact on your revenue cycle by allocating more support for these more complex claims. This is where we come in. Our experienced team of oncology claims experts and third-party resources provide cost-effective human resources to produce complex, clean claims at scale.
Some of the most common bottlenecks in the revenue cycle occur when needed access to patient data is not readily available. With patient data housed in different systems, there can be delays in the processing of patient data.
These present an operational challenge to the revenue cycle when a team member is positioned to move the revenue process forward only to find out that it can’t be done because pieces of the patient’s data are not available.
At OPS, we leverage our experience in oncology practice management to provide our clients with cutting-edge technologies that allow for more seamless access to patient data. Our experts integrate patient data systems to provide our practice management team with real-time patient data so that bottlenecks in the revenue cycle are alleviated.
Many oncology practices are not aware of opportunities to grow their revenue within the revenue cycle itself. Other oncology practices are aware of these opportunities but lack the time and resources to take advantage of them.
No matter what your present situation is, we are here to help. We can improve your revenue cycle by identifying all of the opportunities to grow revenue for your practice. Examples of these opportunities include payor contract review and value-based payment program optimization. By taking advantage of these growth opportunities, you will not only improve your revenue cycle, but you will increase the revenue for your practice in the process.
A key aspect of managing the revenue cycle for oncology practices is high-quality and efficient accounting systems. One area where accounting systems often fall short in oncology practices is in the tracking and reporting of expenses and being able to allocate those expenses across the revenue cycle.
One of our core practices here at OPS is specialized revenue cycle accounting for oncology. Our accounting teams know exactly how to best set up and run your accounting systems for maximum efficiency and compliance. One of the inherent results of these best practice accounting methods is increased visibility into analytics around practice management expenses.
By now you know all too well how your revenue cycle can easily eat into your profits each month. When you have us implement our tailored oncology practice accounting solutions you gain granular-level insight into your expense allocations. We use these insights to help optimize your revenue cycle and decrease total expenses.
We understand that your passion is caring for your patients. Our passion is relieving you of the burden of revenue cycle management so that you can focus more on your patients and earn more income in the process. It truly is possible to do both. To learn more about how OPS can improve the revenue cycle of your oncology practice, contact us today!