More and more commercial plans, particularly Medicare Advantage plans, require authorizations for radiation therapy.  According to CMS, in 2017 one-third of all Medicare recipients were enrolled in a Medicare Advantage Plan. Depending on your market, your volume could be even higher. These plans almost all require pre-certification, and not understanding the guidelines for each plan can be unnecessarily costly. The lost value of just one unsuccessful peer-to-peer case can be upwards of $50,000 for hospitals and physicians. Your radiation therapy center or department simply cannot afford to stay with the status quo prior authorization program and procedures.

RBS has developed a Revenue Navigator Program™ for both freestanding and hospital-based practices that has successfully reduced peer-to-peer reviews to less than 1% of cases. Our proven results save valuable time and resources within the department. In addition, the program has virtually eliminated delays in treatment due to insurance issues and the need for written appeals by the ordering physician.

Not only does the RBS Revenue Navigator Program increase productivity for the department, it alleviates some of the patient financial stress that comes with a serious and sometimes life-threatening diagnosis. Patients value having an expert in the department who fully understands their insurance benefits and pre-certification requirements.

Dr. Richard Byrnes, Radiation Oncologist at Northwell Health, says, “Since having a RBS Revenue Navigator on site our billing has been seamless, and my distraction of doing peer-to-peer reviews has been minimal. Patients enjoy meeting her and are reassured their billing and insurance claims will be handled in a timely and professional manor.  She is part of our team in every way.”

Want to learn more? Contact us to learn how the Revenue Navigator Program™ can add value to your department today.