Healthcare has become increasingly complicated, and navigating the intricacies of oncology revenue cycle management has unique challenges. The constantly growing administrative burdens of managing bills, prior authorizations, and regulatory requirements can overwhelm in-house teams. These complexities divert valuable resources and can pose significant risks to the financial well-being of oncology practices. To effectively overcome these hurdles, practices should partner with an oncology billing services expert. They’ll be able to provide specialized knowledge, decrease administrative burdens, and improve processes to ensure optimal revenue flow.
According to Equifax, poor billing practices result in doctors in the US losing approximately $125 billion per year, or an average of about $5 million per provider.
Oncology teams face numerous challenges that can overwhelm practices attempting to complete oncology revenue cycle management in-house. These challenges link together across practice operations, creating a complicated web of processes and requirements.
The highly specialized nature of oncology revenue cycle management requires specialized expertise and tools to ensure accurate and timely reimbursement.
Prior authorizations are a necessary headache in oncology, as costly medications and procedures often require pre-approvals. Variability in payer requirements adds yet another layer of complexity to the process. Teams must invest significant time and resources, gather paperwork, and communicate with payers to avoid delays in time-sensitive care and treatments, which can lead to adverse outcomes. Besides impacts on patient care, errors, and oversights can result in claim denials, further complicating the oncology revenue cycle management process.
Oncology practices must regularly adapt to evolving requirements across healthcare regulations and payer documentation needs, including billing code changes, compliance standards updates, and new documentation practices. Keeping up with these is a significant undertaking that requires ongoing education and training and ongoing updates to systems and processes. Failure to do this can result in denied claims, reduced reimbursements, and sometimes penalties or fines.
All of these processes combine to create significant administrative burdens within oncology practices. The complex nature of oncology treatments demands meticulous documentation, billing, and coding. Multi-layered and specialized patient treatment plans require precise attention to detail throughout the prior authorization and billing process. Of course, this also requires adhering to constantly changing regulatory and payer-specific rules. Any errors can lead to delays in treatments and reimbursements, causing significant impacts on cash flows.
The industry standard is typically one full-time biller for every 10,000 claims processed annually, resulting in an average of 2.7 billing employees per physician.
While many practices have been managing their oncology billing in-house, these growing complications around oncology revenue cycle management have become overwhelming:
Up to 80% of medical bills contain errors or overcharges in the US.
All of these limitations create significant financial implications. In-house teams are often stretched thin, leading to errors that result in costly mistakes. This can manifest as denied claims or delayed reimbursements, impacting cash flows and financial stability. Plus, there are hidden costs of managing an in-house oncology RCM team, such as the time and resources spent on ongoing training and solution upgrades. With so many people overwhelmed with their day-to-day work, there isn’t time to consider larger-picture initiatives that could help practice operations.
Oncology revenue cycle management can improve significantly when partnering with the right experts. Working with the right team makes it possible to manage the existing administrative churn and provide opportunities for ongoing optimization.
We recommend finding an expert RCM with a dedicated team of oncology billing experts. The ideal partner will offer specialized knowledge and insights that ensure your financial operations run efficiently and enhance them. A strong partner has the resources to stay current on the latest requirements and invest in cutting-edge technology solutions, relieving you of that burden.
The ideal RCM partner does more than just manage billing—they streamline the entire revenue cycle, from the first appointment to the final reimbursement. They proactively adopt the latest technology, stay informed of regulatory changes, and deliver specialized expertise to maximize revenue flow. Ultimately, this improves your practice and makes it possible to provide even better patient care.
The ideal oncology billing services partner will enhance the efficiency and accuracy of your RCM processes and work with you to optimize all components of your practice for financial stability so you can focus on your patients.
At TRIARQ, we work with you to develop a trusted partnership beyond basic reimbursement transactions and RCM tasks. We take the time to understand the goals of your practice and work with you to create a tailored strategy that addresses your financial challenges and objectives. We leverage our expertise and technology solutions to bridge the gaps across operations and cash flows. We go beyond just oncology revenue cycle management to optimize all components of your practice operations. This partnership ensures that you not only relieve many of the burdens associated with billing but also have financial confidence in your practice to concentrate more on patient care and less on revenue concerns.
We work with you to develop a strategy tailored to the needs of your practice and your financial goals.