Oncology Convergence Inc.

Revenue Management

Insurance reimbursement in the oncology market, particularly with regard to Medicare, has become a very complicated process in the past few years.

The cost shifting to the cancer patient has made the payment process even harder and puts more of an emphasis on up front financial management of the patient and oncology billing process. OCI’s staff is experienced with the back end process of getting the claims and statements out the door in addition to vast experience in all aspects of:

Insurance Verification

Service Authorizations

Patient Financial Counseling

Drug Replacement

Co-pay/Co-insurance Assistance Enrollment

OCI actively manages practices that include radiation oncology, medical oncology, gynecologic oncology as well as diagnostic imaging services. Our staff has experience with almost every other medical specialty, which allows us to function well with multi-specialty groups and hospitals. Our practices are located in multiple Medicare/state jurisdictions and include clients that vary from small single specialty offices to large multi-specialty academic medical centers. Our clients also work with a varied mix of providers such as physician assistants, naturopaths, nurse practitioners, social workers and genetic counselors.

Hospital and Physician Alignment

Are All of Your RVUs Captured?

OCI and its partners have the expertise and capabilities to assist both hospitals and practices with their transition or provide clarity to their existing relationship. Our services can range from assisting in negotiating the optimal business relationship on behalf of either party, all the way to managing the agreed upon employment or Professional Service Agreement on behalf of the practice and hospital. The value we provide to both the hospital and practice is multifaceted and stems from the fact that we understand the uniqueness of oncology in both the hospital and practice site of service. Our understanding encompasses the differences in billing under the Hospital Outpatient Prospective Payment System (HOPPS) versus freestanding billing on a HCFA 1500, which can reflect the differences in the mindset of each organization.

Our knowledge, experience, and complete understanding gives us the ability to effectively and efficiently manage the hospital oncology service line, the physician practice, the data infrastructure, and the EMR/EHR environment. This “total solution” approach allows us to properly account for ALL services rendered. This ensures that the physicians are receiving the full credit for all of the work they are performing and the hospital is getting paid for those services. Our past experience shows that hospital – physician relationships can deteriorate due to something as simple as differences in data. Therefore, managing and interpreting the data to maintain the reporting capability that the “freestanding” practice is accustomed to seeing is important. The hospital and physicians should understand and agree on the metrics that determine success in the relationship. By clearly defining, measuring, and reporting the metrics for success, the probability for long-term viability is maximized.

Why should you engage OCI to manage your Oncology Service Line Relationship?

We have a team of proven oncology executives with skill sets that include: transactions, mergers, acquisitions, managed care contracting, hospital service line management, physician practice management, hospital oncology revenue cycle management, and physician revenue management

Clinical pathway collaboration and deployment

Revenue Cycle Management

We provide oncology specific billing expertise and services to hospitals and practices

We completely understand the similarities and differences of each site of service and have the knowledge and expertise to ensure that all parties understand the impact of those differences

This experience ensures that all services are billed compliantly and that all associated RVUs are captured and accounted for properly

Hospital engagement strategies

We help ensure that valuable and sustainable relationships are structured between both parties

All healthcare is local and oncology is no exception, therefore one employment model does not fit all markets. Ensuring that the hospital – physician structure matches the market is essential for long-term success

Oncology inventory management expertise ensures that the projected financials meet expectations

Revenue maximization pharmacy practices are developed and deployed

Oncology specific utilization management is typically required

Waste policies and drug replacement strategies are tailored for each institution

Managed Care contracting

Oncology specific knowledge is dependent upon a successful payer strategy

The drive for healthy outcomes requires competitive pricing be dependent upon local market competition for ambulatory services

Competitive pricing ensures that patient volumes and payer mix are maintained for clinical staffing post transition

EMR Enhancement and System Management

Maintain and manage the Oncology specific EMR for both Radiation and Medical Oncology

Creates the comprehensive cancer center experience for the patient

Assists with meeting meaningful use and improve quality

Maximizes charge capture

Why Medical Oncology Total Solutions Management?

Independent oncology experienced entity that:

Ensures the proper capture and coding of all RVUs and ensures compliance

Has the knowledge and expertise to support all parties through every phase of the service line agreement’s lifecycle

We currently work with all sizes of hospital systems including large and small publicly traded health systems, not for profit systems, academic medical centers, and National Cancer Institute (NCI) designated cancer centers.

Electronic Records

Ready to Go Paperless?

The United States government has recognized the need for physicians and hospitals to convert their organizations to paperless environments.

There are a myriad of reasons for this such as:

Improving patient care

Increasing patient safety

Avoiding government penalties

Capturing government bonuses

Simplifying compliance

The government is so assured of these benefits that the HITECH Act (Health Information Technology for Economic and Clinical Health Act) will provide incentives to medical practices and hospitals that accept Medicare and Medicaid patients.

Finding the best EMR for your practice is not as easy as it was in the past. It becomes more complicated when the intricate needs of practicing oncology are considered. Key questions to ask include:

How will you find the best product without sacrificing workflow?

Should you find a product you think suits your needs, how will you know what is the best price?

How will you know if you’ve bought a product that is too expensive, complicated, or not advanced enough for your organization’s needs?

How will you know what ancillary tools to use?

Who will do all the necessary work to actually convert all files and data?

How will you train your practice on the new procedures?

You are not expected to know the answers to all these questions. For that matter, there is no ONE answer. That is why it is extremely beneficial to work with OCI’s consultants from the initiation of your EMR project.

We have already analyzed EMR conversions from an oncology-requirements perspective.

Not all EMR systems have the necessary designs to meet oncology practice needs.

Among those that do, some are better for large organizations, while others fit better with smaller organizations.

OCI’s proprietary Oncology Revenue Recovery™ service provides:

Identification of unbilled charges

Identification of mis-billed units (Over/Under)

Identification of bundled services

Identification of process breakdowns

Somewhere along the way every practice for which OCI has performed Revenue Recovery services has experienced considerable under- or over-payments with their insurance providers.

OCI’s painstaking work in discovering and verifying data anomalies is converted to a turnkey product for the sake of busy oncology practices. Simply preparing and presenting the data is only half the process. Gathering and duplicating all the necessary documents in order to submit them for payment is just as time-consuming. OCI performs that labor for you.

Additionally, OCI’s work carries no upfront costs; we work on a risk-free contingency basis, so it is to our benefit as much as it is to yours to ensure that all appropriate claims are organized and prepared in a timely manner to maximize return. For that reason, we are motivated to make sure that we uncover all revenue opportunities and complete all details necessary to achieve that goal.

In addition to maximizing profits, Oncology Revenue Recovery™ aids your organization in attaining compliance with changing insurance regulations. Simply continuing processes and submitting claims the way it used to be done is often following incorrect procedures today. It is possible to have a profitable oncology practice while still being compliant. Finally, it is to your benefit to discover where your organization has been overpaid before RAC auditors do it for you. Should they find those errors, repayment and fines may be in your future. For more information on RAC audits, you may want to view the CMS website RAC presentation (http://www.cms.hhs.gov/RAC).

The Tool for Oncology Management

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The rising cost of cancer care is hitting patients and practices throughout the country. It’s now more important than ever to financially counsel patients to help them deal with the rising costs and keep your practice financially sound. At Oncology Convergence, Inc. we have developed a tool that helps you do that and more. We are proud to present OncoAdviser. OncoAdviser can help you:

Access insurance billing and coding guidelinesDevelop cost of treatments for patientsCrosswalk ICD9 codes to ICD10Analyze the profit and loss of a patient’s treatment/regimenAccess patient education toolsProvide a web portal for patients or staff to track symptoms and side effectsAccess pharmaceutical assistance programsTrack dispensed medicationsReference drug information such as NDC’s, dosing guidelines and related information

If you are already providing these services to your patients we can make you 75% more efficient and if you don’t, we can help you get started on a path of increased efficiency and profitability.