Frequently Asked Questions
Revenue Management
How is OCI’s Revenue Management different from typical billing company service?
OCI’s Revenue Management is designed specifically for the challenges of oncology reimbursement. We perform typical billing services, such as processing and appealing claims. But, just as importantly, we analyze all areas of the business front-to-back to advise our clients on how to best maximize revenue.
What can I expect from OCI’s Revenue Management?
We customize our services around the needs and expectations of each individual client. So, our level of involvement in our clients’ daily needs varies depending on those needs and expectations.
Why does OCI specialize in oncology Revenue Management?
Over the past few years, billing for oncology services has become increasingly complicated and reimbursement amounts have been steadily reduced. It has become a challenging endeavor to keep up with optimal revenue maximizing procedures. OCI’s staff is well aware of these difficulties and how to guide our clients in maximizing revenue while maintaining compliance. It is still possible to have a profitable practice, and because OCI specializes in oncology reimbursement, we know the best ways to achieve high profitability.
What kind of access do OCI’s clients get to their billing data?
OCI feels it is very important that our clients can see their billing data when they want to. For that reason, our clients can view their data at any time via a secure link to our client portal.
Radiation Revenue Recovery (R3) and Infusion Revenue Recovery (IRR)
What is Revenue Recovery, and what is involved in the process?
OCI’s Revenue Recovery services are four-step process designed to identify clients’ billing irregularities that resulted in an under and/or overbilling event. The steps begin with a software scan of all billing data followed by intense analysis, review and verification of all events identified by the software algorithms. OCI does most of the work so as not to burden our clients with time-consuming projects. Any missed reimbursements OCI finds are prepared with proper verification documentation in a turnkey product ready to be submitted to insurance providers.
What is Radiation Revenue Recovery (R3)?
R3 is designed specifically for the intricacies of radiation oncology billing. It includes all procedures and office visits and can be performed for any radiation oncology site, regardless of whether the billing data and/or charts are electronic or paper.
What is Infusion Revenue Recovery (IRR)?
IRR is designed specifically for the intricacies of medical oncology billing. It includes all procedures, office visits and drug infusions, plus it reconciles with automated drug cabinet reports. With chemotherapy reimbursements dropping to single-digit margins, it is extremely important to identify missed charges as well as how to prevent missing them in the future. IRR will do both of these for you in addition to identifying other areas to maximize reimbursement.
How is Revenue Recovery different from other internal or external audits?
In a typical audit, an adviser works onsite to review 20-30 actual patient charts and from those charts, determines whether a practice or center is billing services in a compliant and efficient manner. Since the auditor only looks at a small percentage of charts, they may miss some patterns that would be caught in a larger sample, and any missed reimbursements will have to be later found by center’s own billing personnel. OCI’s Revenue Recovery examines all billing data, finding every anomaly that resulted in an under or overbilled event. All patterns are caught so that our analysts can advise on how to maximize reimbursements going forward. Consequently, Revenue Recovery provides a thorough and complete review of all billing data, while a typical audit is a small sample of charts.
How does OCI charge for Revenue Recovery?
Revenue Recovery is a contingency-based service that charges a percentage on identified and collected unbilled charges as well as on opportunities found. There are no “hidden” fees.
Why does Revenue Recovery identify overbills, rather than just underbills?
Overbills are increasingly under close scrutiny by CMS in the form of RAC Audits. Recovery Audit Contractors are paid a percentage of overbills they find, so it is to their benefit to identify every possible time CMS has been overcharged. And, according to CMS’ website (http://www.cms.hhs.gov/RAC/), “…if you bill fee-for-service programs, your claims will be subject to review by the RACs.” Since OCI’s Revenue Recovery provides a complete analysis of all billing data, we can identify non-compliant patterns and procedures that would be caught by a RAC auditor. Armed with that information, your office can adopt more compliant procedures before it becomes a target of a RAC audit.
Consulting
What sorts of consulting services does OCI offer?
With years of experience in the field of oncology management, OCI’s experts can provide guidance and support for a wide variety of services.
Our most frequent requests include:
Process training
EMR conversion
Vendor selection & negotiation
Employee search and interviewing
New practice
Technology upgrade & conversion
Practice growth & expansion