diagnosis: missed opportunities for payment by ProQuest


Physicians and the billing professionals with whom Southeastern New Mexico Hematology & Oncology of Roswell, NM, worked will remember 2005 as the year Medicare clamped down on drug reimbursements. At the time, Southeastern New Mexico Hematology & Oncology was eight years old. The new Medicare rules meant that drugs once paid at 110% to 120% over cost were now paid at just 6% over the manufacturer's national average sales price. The new payment rules virtually eliminated its profit margin on most of the drugs critical to absorbing the indirect costs associated with administering chemotherapy. Suddenly, billing problems previously masked by Medicare's more generous payment policy began to take their toll. The more intimately it came to understand the revenue cycle problems of its own practice, the more we realized others must be in the same predicament. By outsourcing the time-consuming, troublesome details associated with billing, its practice has been able to refocus attention on patients.

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