QLTI-05. Increasing revenue generation for neuro-oncology patients by using a billing education intervention: a quality improvement initiative

BACKGROUND In 2021 CMS billing changes led to our identifying inappropriate billing practices by Advanced Practice Providers (APPs) within our institution. These practices often resulted in underbilling and services rendered for which no bill or no Relative Value Units (RVUs) were generated. Problematic neuro-oncology visit types included patient education for oral medications, clinical trial visits, prolonged discussions about end of life/hospice, survivorship issues and recognition of complex care coordination. METHODS We developed an educational intervention aimed at enhancing oncology APPs’ understanding of appropriate billing practices. This initiative was presented during a mandatory training session for all APPs within our cancer center. The presentation covered appropriate levels of billing, nuances of prolonged services, care coordination, procedures, and other visit types which are common to all neuro-oncology patients. We measured baseline RVUs generated by Neuro-Oncology APPs for 4 months (January-April 2022) prior to educational intervention compared to RVUs generated post-intervention (January-April 2025). Total number of APPs, FTEs, and clinic slots remained constant during the interventional. Outcome measure was change in RVUs billed by APPs. Process measures included visit types for education, clinical trials and procedures, and APP participation in billing education. Balancing measure included physician productivity and RVU generation. RESULTS Pre intervention, total RVUs for three Neuro-Oncology APPs were 345.58 (average of 86.4 RVUs per month). Post intervention, total RVUs were 1504.81 (average of 376.2 per month). This equated to an overall RVU increase of 435%. CONCLUSION This educational intervention drove a notable increase in RVUs without adding additional APP FTE, indicating improved billing practices and enhanced recognition of the services provided by our APPs. This initiative reinforces the importance of accurate billing and billing training in complex neuro-oncology patients.