Often, oncology practices lose income because they miss capturing and billing charges accurately 100% of the time. Fortunately, more often than not, that income can be recovered. With tens—or even hundreds—of thousands of line item transactions to manage, it’s impossible to bill perfectly, even with the best efforts of dedicated, loyal, proficient employees. But even a low percentage of errors can equate to a significant amount of lost income.
In the late 90s (the glory days of drug reimbursement), I was working as a controller for a practice of about 20 oncologists. Occasionally, I’d find that the drug cost percentage (drug cost/drug charges) would be outside of the typical range. After extensive research, I discovered that these fluctuations were consistently the result of missed drug charges and various types of charging errors. This discovery inspired me to create Revenue Recovery.
Revenue Recovery is a process in which we identify and recover missed charges that are still within filing deadlines. In addition to bringing in income from previously lost charges, we learn valuable information that helps us avoid the same losses going forward. The financial benefit of not only recovering income, but avoiding the same process failures in the future, can be significant.
With Revenue Recovery, an oncology practice assumes no upfront cost. Having an expert third party like The Oncology Group analyze charge capture at no risk makes perfect sense. We work independently, mostly offsite, minimizing disruption to your day-to-day operations.
They say that the only thing that doesn’t change in life is change. Medical oncology is complex, because it’s fast-paced and has complicated drug names with different billing unit conversions. We see constant change with new drugs, uncommon drugs, drug code changes and changes in billing unit conversions. We must also manage issues with employee turnover, procedures not followed, inadequate training, understaffing, distractions and human error. I have never seen an organization without one or more of these issues. At any given time, every organization faces them.
Lost income varies over time and by organization. Reimbursement continues to decline while costs continue to increase. To maintain net income, you have to be smarter or grow every year. One sure way to maximize your income is to take care of your existing business. In addition to perfecting your frontend revenue cycle processes, you must capture, bill consistently and verify accurate payment. That’s very easy to say and much harder to achieve.
Consider the cost—and the strain on your organization—of not capturing or billing correctly for a drug that costs $5,000 and generates a 10% profit margin. In order to recoup the out of pocket costs for that one missed charge, you’ll have to administer $50,000 worth of the drug and collect 100% due from insurances and patients. Your organization cannot afford missed charges, especially considering the many other challenging obstacles of the revenue cycle you must contend with.
In my 18 years of working on recovering revenue, I’ve learned that all organizations can benefit from it. Successful, stable oncology practices have seasoned, knowledgeable and attentive professionals. They follow tight procedures and constantly focus on improvement. But every well-run oncology practice will have occasional slip-ups. Even organizations doing a stellar job may fall prey to significant missed revenue if they experience turnover or become understaffed. Often, neither the physicians nor their staff is aware of where the process is weakening and significant process failures can result in financial ruin.
That’s where The Oncology Group’s Revenue Recovery comes in. We apply an unbiased, factual approach to helping physicians and organizations achieve a more financially successful business. We are compensated with a minority share of incremental realized collections, so there’s no risk or upfront cost.
My team and I are here to help you put more money in your pocket. The Revenue Recovery process works to make sure you get paid for everything you do for your patients. Please contact us at email@example.com or 512-583-8815 to learn how The Oncology Group can work for you.