Understanding Radiation Oncology Billing, Collections, and Insurance Issues

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...