Untangling the Messy Oncology Business Office with Technology Delivers Millions in Missed Revenue

Subhead: As the world of cancer care evolves into precision medicine, back-office systems haven’t kept up, leaving millions in underpaid revenue in the hands of payers and frustrated oncology practices unable to see a true picture of their financial health.

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Doctor looking at ct scan

By Corinne Kereszturi, President at AC3

In the constantly advancing science of cancer care – expanding into immunology and genetic drugs, unlocking personalized vaccines, and finding ways to prolong and save the many lives touched by cancer – the complexities of managing the business side of healthcare has magnified, putting a deep strain on oncology practices, causing many to suffer.

Under the tangle of different systems, each segregating data into silos, you’ll often find a staff burdened by manual processes and complex payer requirements (prior authorizations and denial management) just to get bills out the door and cash in. They don’t have time or the resources to dive into millions of lines of data to identify underpayments, missed billings, underbilling and other revenue discrepancies. 

It is fair to wonder why someone hasn’t fixed this problem yet, until you realize that just billing accurately requires navigating numerous payer contracts, hundreds of ambiguous fees schedules, various methodologies, innumerable exceptions, tens of thousands of CPT/NDC codes and ever-changing updates.

Oncology powerhouse Michiana Hematology Oncology (MHO) initiated a process to streamline their backend business processes. 

How it started for MHO — and How it is Going Now. 

Prior, using cumbersome manual processes, MHO was only able to update the fee schedules—which tell them how much they would be paid for their services—for their biggest payers. And even for those payers, they were only updated twice a year, while the fee schedules themselves changed at least once per quarter. Fee schedules for the remaining payers were missing from the picture entirely. Without accurate fee schedules across all payers, there was no way to identify issues where payment was missing or wrong. While they could identify some large discrepancies by manual auditing, it was the multiple hundreds of smaller discrepancies that were eating away at practice revenue.

After implementation of AC3’s Oncology Intelligence Solutions, within one year, MHO added $1.66 million in additional revenue to its bottom line due to improved net collections rate, in addition to underpayment revenue recovery of $2.8 million for patient treatments and $333,000 in missed drug billings. With true revenue integrity in hand, MHO’s ability to invest in growth and innovating patient care increased exponentially.

The MHO-AC3 Connection

CEO Susan Ford described the importance of revenue integrity to MHO, the largest oncology practice in northern Indiana. “We started this journey because MHO recognized that the status quo was not sustainable and without a strong technology partnership we would never be able to do this on our own.”

At first MHO attempted to solve these challenges on their own. Ford talks about the journey that led to creating AC3, “Initially we launched an 18-month project to reorganize our back-office teams processes, and workflows. But we realized quickly that our team needed technology to integrate systems, streamline processes and identify cost savings, and that technology was not on the market. In our mission to achieve revenue transparency and integrity, we chose to invest in developing technology to solve this problem.” As a result, AC3 was formed. 

The decision to embed AC3 into the MHO practice meant that it could test and harden this evolving financial and business technology platform with the real-world challenges of an actual oncology practice.

Development started with the fee schedule. The inability to efficiently and accurately update and integrate contractual fee schedule rates from insurance companies into oncology billing systems robs practices of profit. This is true across the medical industry, but it is especially acute in oncology, because of the complex treatment protocols and the extreme dollar amounts unique to oncology care delivery. 

AC3 continued to scale the intelligent fee schedule design to encompass 100% of payers being mapped to accurate fee schedules. By removing manual processes and simplifying fee schedule management, AC3 opened up transparency into all of MHO’s fee schedules and the ability to easily detect contract issues.

Continuing Evolution of Data Integration

AC3 then united data from multiple systems, including practice management, billing and dispensing systems into a single environment. Integrating the fee schedules tells you how much you are allowed to bill. Only when you actually incorporate the treatment protocol and pharmaceutical dosages prescribed, as well as the actual dosage administered, can you know what to bill. 

With the data united, AC3’s intelligent auditing capabilities could process and simplify billions of data points a day, including diving deep down to the individual transaction level of every claim and validating them against the contractual fee schedule allowances to uncover revenue opportunities. 

Revenue, True Financial Health Visibility & Data-Driven Efficiencies

Leveraging AC3’s Oncology Intelligence Solutions and data analytics delivered impressive, tangible revenue benefits. By interconnecting intelligence between the financial, operational and productivity data, MHO was empowered with a more holistic, transparent view of the practice’s overall performance. The ability to accurately predict incoming revenue — not just billed charges — opened the door for the practice to move to an accrual accounting method from a cash basis. This in turn improved net collections rate resulting in an additional $1.6M to the bottom line.  

Furthermore, MHO gained visibility into future patient appointments and treatment needs across MHO’s 10 locations, enabling the practice to allocate inventory between multiple sites daily to optimize utilization and minimize high inventory levels, resulting in a 60% increase of cash on hand due to reduction in pharmaceutical inventory required.

By gaining a clearer view of the true health of the practice, MHO was able to bring new leadership swiftly up to speed with a more accurate picture of what was happening in the practice.  It also enabled better business planning, forecasting and access to new capital investment opportunities.

A New Era of Oncology Practice Management

CEO Susan Ford emphasizes the before and after of managing an oncology practice with the insights afforded by AC3 Oncology Intelligence Solutions. “Without AC3, it would take us months to do what they could get to us in a moment. AC3 has simplified many back-office billing and operational processes in addition to accelerating access to meaningful data insights. It’s the right data insight at the right moment to allow MHO to perform its best.”

With AC3’s oncology intelligence solutions in place, MHO now has increased revenues plus insight into business operations allowing them to stay independent and affording them the capacity to explore different avenues to better position the practice for long term sustainability. And more importantly, MHO can focus on improving access to quality healthcare for its community today and tomorrow.

About Corinne Kereszturi

Rooted in a mission to reduce the overall cost of healthcare, Corinne drives the strategic growth and development of AC3 and its healthcare intelligence solutions. 

A career dedicated to transforming healthcare organizations, Corinne joined AC3 in 2017 as Vice President of Data Solutions where she initiated the development strategy and commercialization of AC3’s digital platform before stepping up to Chief Operating Officer in 2018 and President in 2020. 

Prior to joining AC3, Corinne partnered with leading US health systems and medical practices, working side by side with providers to enhance the patient experience while serving as Vice President of Advisory Services at Press Ganey, leading a team of 100+ Advisors. In addition, she served as Vice President of Product Development, where she drove the patient experience strategy and solutions development. 

Corinne also serves as a board member for Children’s Dispensary, which provides programming and support to people with special needs and their caregivers.

For more information on AC3 go to ac3health.com

For more information on Michiana Hematology Oncolcogy go to michianahematologyoncology.com.