Oncology revenue cycle management when integrated into multi-specialty practices creates distinct operational and financial difficulties. Billing in oncology is one of the most complicated medical billing subspecialties. This is due to a combination of high-dollar pharmaceuticals, the need for infusions, prior authorizations, and the dynamic nature of the rules of reimbursement. Billing becomes more complicated in multi-specialty practices that include oncology billing in the same practice as cardiology, urology, internal medicine, or surgery. This is where contractual-based Healthcare RCM Services become advantageous.
Contractual-based RCM in oncology cycles allows multi-specialty practices to legally outsource the billing and reimbursement functions specific to oncology, which are governed by service level agreements (SLAs). These SLAs specify performance goals, compliance deadlines, and reporting and accountability frameworks, which promotes transparency and concrete, quantifiable outcomes.
The Integral Role of Oncology-Focused RCM Contracts in Multi-Specialty Practices
Oncology billing requires expertise that is specific to the subspecialty in order to correctly code and bill for services such as the administration of chemotherapy, immunotherapy, and radiation therapy, as well as for the administration of high-cost injectable medications. The absence of these services creates a financial risk that the practice will lose a significant amount of revenue due to billing errors. Internal billing and coding functions that are performed by practices that do not specialize in oncology billing frequently suffer from a high rate of claim denials, delayed claim payments, and an elevated level of risk for regulatory compliance.
Multi-specialty practices that choose to outsource their billing and revenue cycle management functions obtain, as a direct benefit, access to oncology-specific coding professionals, denial strategies, and reimbursement analysts. These individuals are specialists in oncology billing and are intimately familiar with the documentation, coding, and claim submission procedures that must be followed in order to comply with the reimbursement rules for oncology services of various payers.
Contract models also enhance efficiency. Multi-specialty groups can adjust their offerings based on patient numbers, seasonal changes, or new oncology service line offerings. Rather than spending time and financial resources on recruiting and training new employees, companies can benefit from contract models where potential costs and revenues are aligned.
Contract-Based Components in Oncology Revenue Cycle Management
A solid oncology RCM contract should clearly outline:
Pre-certification and authorization: Oncology costs are high, therefore, these treatments require prior authorization.
Oncology coding and charge capture: Oncology services, supportive care, and infusion services require specific coding and charge capture.
Claims submissions and payment postings: Effective claims submission are critical in reducing claims rejection.
Denial Management and Appeals: active strategies should be in place to identify denial trends and develop strategies for resubmission quickly.
Monitoring compliance to: to maintain compliance with payer policies and oncology-specific billing.
Analytics and reporting: funds on-demand (FOD) and closed (FCE) and open (OCE) claims, and open balances (OB) and denial (D) trends reporting.
Providers RCM services continue to be a pillar of financial stability for multi-specialty groups.
Financial Impacts on Multi-Specialty Groups
Contract models in oncology RCM offer a shift in financial liquidity. With the establishment of performance metrics, practices can evaluate their collection efficiency, the average days in account receivable, and the aggregate uncollected accounts. Most of the vendors operate on a performance-based pricing structure, thus aligning service costs with the generation of new revenues.
Furthermore, outsourcing involves less administrative oversight. There will not be continuous employee training, software updates, or compliance reviews, as these duties become the responsibility of the RCM partner.
Better Compliance and Risk Management.
Due to the nature of the industry, and Oncology Billing being constantly audited and updated, contracting Healthcare RCM Services means the provider will be updated to the current CMS guidelines, payer policies, and value-based care structures, which overall keeps compliance risks low and avoids financial audits and penalties for multi-specialty groups.
Conclusion
For multi-specialty groups that deal with complicated oncology services, the oncology RCM that is contract-based gives them structure, flexibility, and financial value. By utilizing RCM Services for Healthcare and RCM Services for Providers which are specialized, multi-specialty groups will have minimized services denials, fast-tracked reimbursements, and will be able to concentrate on providing excellent cancer care. The RCM contract that is focused on performance is, in the current reimbursement system, not just an operational decision, it is also a tactical choice to secure the revenue for the future.
