Optimizing your claims process with technology enabled services and support
| What it does | Evaluates your practice, identifies strengths and weaknesses and tailors a solution for your needs. |
|---|---|
| Areas addressed | Revenue, operational cost, collections, patient satisfaction, value based payment models. |
| Evaluation | ClaimHealth® will audit 100% of claims providing an in-depth report and interactive dashboards. |
| Tools | Your practice trends will be populated into the Patient Estimator and RO Predictor. |
| Education | Tailored on-site training based on our evaluation to improve the accuracy for all future claims. |
| Keeping you current | A monthly newsletter to keep your staff up-to-date on the most recent rulings and changes. |
| Access our experts | A private questions and answers portal will provide immediate answers to your questions. |
| Deliverable | One comprehensive solution to strengthen your practice and increase your bottom line. |
| The Legion difference | We are administrative and clinical service line experts who understand the challenges of the modern-day RO practice. |
We are the only consultants who provide a start-to-finish, tailored solution.
RADIATION ONCOLOGY OPTIMIZATION SUITE
How does it work?
Value Proposition
- Ensure revenue integrity with Legion’s ClaimHealth® audit analysis
- Increase revenue by improving billing and coding accuracy and workflow efficiency
- Reduce operational cost by maximizing all workflows (clinical and administrative) in your center
- Maximize revenue with or without the APM by leveraging claims data with operational data
Observed Impact of Billing Errors by Center
Where does your center fall in this range?
Legion’s Radiation Oncology Optimization Suite can help your hospital with revenue integrity, operational KPIs, and compliance.
Benefits
RADIATION ONCOLOGY OPTIMIZATION SUITE
ClaimHealth®
Defines the R.O.I [Revenue, Opportunity, Institutional Risk] of an Institution’s claims (i.e. charges overbilled, underbilled, no payment, partial payments)
Authoritative Rules and Guidelines
- Payor guidelines: Medicare and Commercial
- National Correct Coding Initiative (NCCI)
- Policies and procedural edits–Medicare Claims Processing Manuals, Program Integrity Manuals, Annual NCCI Manuals
- Issues targeted by audits by MACs, RACS, ZPICs, Office of Inspector General’s Annual Work Plan
- Department of Justice rulings or cases
Does your radiation oncology department want to know the following key information about their revenue cycle and operations?
- Billing and coding errors based on all of Medicare and Commercial Payor authoritative guidelines
- Missed billing opportunities (i.e. lost revenue from codes not billed)
- Inconsistent payment trends or partial payments by payor
- Potential institutional risk
- How to reduce backend denials
- Estimate the potential impact of the RO-APM
RADIATION ONCOLOGY OPTIMIZATION SUITE
ClaimHealth®
Operational Dashboard
Monitor operational trends, utilization patterns and financial data
The ClaimHealth®Operational Dashboard provides strategic business insights and personalized data for administrators that balance efficacy, productivity and cost. The analytics dashboard allows data visualization for reviewing physician productivity, disease site trends, technology, modality and code utilization, claims payment status, insurance carrier trends and much more.
- Payor breakdown—Payor breakdown by cancer type.
- Reimbursement rates—Reimbursement rates by payor by CPT code.
- Utilization rates—Utilization rates by cancer type and technology (i.e. 3D vs. IMRT vs. SBRT).
- Case rates—Case rates by cancer type and technology (i.e. average payment per patient).
- Protocols—CPT codes by cancer type (i.e. average basket (protocols) of charges (CPTs)).
- Fractionation patterns—Fractionation patterns by cancer type by physician by year (i.e. trends in treatment regimens over time).
RADIATION ONCOLOGY OPTIMIZATION SUITE
Transparency and
Estimator Tool
Accurate patient cost estimates at the point of service
The Transparency and Estimator tool allows practices, departments and providers to produce accurate patient estimates based on geography, volumes and place of service. The program can be customized with Medicare allowable rates, commercial rates and more importantly protocols will be customized based on current utilization patterns using the data analysis from ClaimHealth®.
The Transparency and Estimator tool streamlines the financial counseling process at the point of encounter based on actual utilization trends and accurate protocols, ensuring compliance with the new rules on price transparency that will be mandatory and effective January 1st, 2021.
RADIATION ONCOLOGY OPTIMIZATION SUITE
Radiation Oncology Answers OnDemand
Access to industry experts to answer all of your radiation oncology billing, coding and compliance questions
A private question and answer portal will provide immediate answers to staff questions, with a way to track answers for future reference. The platform was created with accessibility, searchability and security in mind and is HIPAA compliant.
RADIATION ONCOLOGY OPTIMIZATION SUITE
Value Based Payment Model Analytics
A review of episodic payment models based on the proposed Alternative Payment Model (APM) by CMS for payment classification by diagnosis. APM analytics will compare your current payments to the proposed 34 disease sites utilizing trend factor, case-mix adjustment, historical experience adjustment and geographic adjustment.
Contact us for more information about our proton therapy solutions, business intelligence, education, data analytics and healthcare consulting services.
ABOUT US
By definition, the word Legion means an immeasurable crowd, vast host, multitude or number of people. Our Legion takes the fight against cancer to heart.
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CONTACT US
2001 Kirby Drive
Suite 1100
Houston, Texasinfo@legionhp.com
650-600-0001
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