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Understanding Radiation Oncology Billing, Collections, and Insurance Issues

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Understanding Medicare

For patients who have Medicare Part B as their primary insurance (these are the majority of radiation oncology patients), Medicare has a predetermined fee which is paid for each medical procedure, billed as a current procedural technology (CPT) code. Medicare pays 80% of this allowable, and the patient’s secondary insurance pays the remaining 20%. Charges are electronically billed, turnaround time to receive payment can be as few as 14 days. Some secondary insurances will take between 6 and 9 months to pay the final 20%. Many secondary insurances must be billed using a paper claim sent through the mail instead of an electronic claim, thus delaying payment for up to 6 months (Schilling 2007a). Medicare Part B provides outpatient services for patients in a bundled fashion – professional and technical components of radiation treatment are paid in one lump sum.

Hospital-owned, hospital-based radiation oncology practices bill under Medicare Part A. This provides for a...

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References

  • CMS (2010a) Centers for medicare and medicaid services web site: sustainable growth rate 2010. www.hhs.gov.med

  • CMS (2010b) Centers for medicare and medicaid services web site: medical economic index 2010. www.hhs.gov.med

  • Schilling PJ (2004) Managing the insurance denials and appeals process. American college of radiation oncology practice management guide. American College of Radiation Oncology, Bethesda, pp 67–69

    Google Scholar 

  • Schilling PJ (2005) Tips on how to appeal denied medicare claims for radiation oncology. American College of Radiation Oncology ACROGRAM, May 26, 2005

    Google Scholar 

  • Schilling PJ (2006) Radiation oncology negotiation for managed care. American college of radiation oncology practice management guide. American College of Radiation Oncology, Bethesda

    Google Scholar 

  • Schilling PJ (2007a) Economics of radiation oncology, chapter 98. In: Halperin EC, Perez CA, Brady LW(eds) Perez and Brady’s principles and practice of radiation oncology, 5th edn. Philadelphia, Lippincott Williams & Wilkins, pp. 2043–2049

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  • Schilling PJ (2007b) ACRO alert: beware of the silent preferred provider organization. American College of Radiation Oncology, Bethesda, MD

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  • Schilling PJ (2009) ACRO alert: medically unlikely edits do not mean impossible reimbursement. American College of Radiation Oncology, Bethesda, MD

    Google Scholar 

  • Schilling PJ (2010a) ACRO alert: code 77338 replaces 77434 multiple custom multileaf device charges for medicare IMRT patients

    Google Scholar 

  • Schilling PJ (2010b) ACRO newsletter: do medicare HMOs cherry pick healthy seniors to enroll? August 2010

    Google Scholar 

  • Tippet TN (2006) Emergence of the silent preferred provider organization. J Fla Med Assoc 6–7

    Google Scholar 

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Correspondence to Paul J. Schilling M.D., FACRO .

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© 2013 Springer-Verlag Berlin Heidelberg

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Schilling, P.J. (2013). Understanding Radiation Oncology Billing, Collections, and Insurance Issues. In: Brady, L.W., Yaeger, T.E. (eds) Encyclopedia of Radiation Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85516-3_156

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  • DOI: https://doi.org/10.1007/978-3-540-85516-3_156

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