Proton therapy represents the highest level of complexity in radiation oncology. More systems, more documentation requirements, and a prior authorization process that can feel like a second full-time job. The people doing this work are some of the most innovative in the field. But they are operating inside systems that weren’t necessarily built for the pace and complexity proton care demands.
That tension was the focus of a recent NAPT webinar hosted in partnership with Fuse Oncology, where three members of the Fuse team — each with deep roots in radiation oncology — walked through the financial, documentation, and workflow challenges specific to proton centers, and demonstrated what modern solutions look like when they’re deployed in practice.
Same Problems, Higher Stakes
Brianne Raulston, a radiation therapist who spent 14 years in the field — 12 at Mayo Clinic in Arizona, nine of them in protons — opened the webinar with a framing that anchored everything that followed.
“Protons don’t necessarily have different problems than photons,” said Raulston, an account manager with Fuse Oncology. “It’s the same challenges the whole field is navigating — financial pressure, documentation burden, and workflow complexity. They’re just more amplified here. Margins are tighter, so every charge capture gap and coding error carries greater impact. Documentation lift is heavier. Throughput, scheduling, and consult-to-treat timelines are all harder to manage when margins are this tight.”
The stakes of getting it wrong are simply higher. Each proton treatment is worth more. Patient pools are smaller. Insurance coverage is contested more frequently. But Raulston was direct: the problem isn’t the people. It’s the tools and workflows surrounding them.
Fuse Oncology was built from that conviction. Two medical physicists at Cone Health — BJ Sintay and Dave Wiant — set out to rethink radiation oncology workflows end-to-end, targeting a consult-to-treatment time of 24 hours. The infrastructure they built for their own department became the foundation of what Fuse now brings to centers nationally. Cone’s results stand as the proof of concept: shorter consult-to-treat timelines, reduced rework, improved margins, and expanded capacity — even after losing a physician from the team.
The Charge Capture Problem
Matt Terry, Fuse’s VP of Consulting and a radiation oncology practitioner since 1999, delivered a finding that landed hard with the audience: charge capture errors aren’t an anomaly. They’re universal.
“Every clinic misses charges. Every clinic has compliance concerns. Every single one of them,” Terry said. “Our S!GNAL install base alone has flagged over $219 million in corrections — and that number is three to six months old, so it should be quite a bit bigger than that now.”
The reason is largely mathematical. At a center treating 50 patients per day, with an average of three codes per patient and roughly six checks per code, a thorough daily charge review involves approximately 900 data points. That level of scrutiny isn’t realistic for clinical staff who are also managing everything else. Reviewers skim, assume a later audit will catch what they miss, and errors compound quietly over time.
For proton centers, the impact is amplified. Higher per-treatment costs mean each missed charge represents a larger revenue loss, and there’s less margin to absorb it. Data from a Fuse review of 400-plus proton courses found an average of 2.4 errors per course and roughly 70 missed charges per 100 courses — with treatment delivery, not complex planning codes, among the top sources.
Fuse’s S!GNAL product addresses this through daily AI-assisted review that filters the charge list to only the cases requiring human attention. When 89% of charges pass automated checks, staff focus on the 11% that need them. Across five quarters and multiple organizations, the share of errors corrected within 30 days improved from 26% to 74%.
The same continuous-tracking philosophy extends to prior authorization. Getting an authorization approved is only half the job and keeping it current as treatment evolves is where most systems fall short. Fuse is building authorization workflow management that monitors delivered services against what was authorized, alerts staff before burn-down thresholds are reached, and flags course-of-therapy changes in real time so reauthorization can happen before it becomes a problem.
The Documentation Burden
Christel Smith, Fuse’s CTO and former Varian proton solutions product manager, came to the documentation problem through data. Across Fuse’s customer base, documentation errors — missing records, wrong document types, incomplete information, missing signatures — were consistently among the most common sources of charge capture failures and claim denials. And behind those errors was a care team stretched thin.
Radiation oncology burnout is reported at 38%, higher than many other medical specialties, with documentation and charting cited as the leading cause. The ACR’s 2023 Wellness Report noted that radiation oncology is hit harder than most fields because of the need to manage documentation across OIS, EMR, and third-party systems simultaneously.
“Clinicians are saving at least 40 minutes per new start,” Smith said. “We’re giving these doctors back their Sundays and time with their families. We even heard from one clinician that he had an emergency patient, and without this workflow, he wouldn’t have been able to see that patient before he had to travel.”
Fuse’s documentation tools automate the consult preparation workflow: identifying upcoming appointments, retrieving relevant records, extracting key data points using AI and OCR, and pre-populating a structured note for physician review. The system spans 30-plus disease groupings and went live with its first customer in 2025.
Beyond consult prep, Fuse’s RX module captures physician intent at the point of first consult — simulation parameters, fractionation, dose goals, prescriptions — and distributes it downstream to every system that needs it. If anything changes during treatment, a change management workflow updates all clinical documentation simultaneously, eliminating the mismatches that create compliance risk and denial exposure.
Implementation is faster than most centers expect. With an engaged IT team, technical integration typically takes a couple of weeks. S!GNAL configuration runs about three weeks, with Fuse’s consulting team embedded with clinical staff throughout, identifying workflow improvements even before go-live.
The Integrated Picture
The through line across all three sections was consistent: individual tools help, but the meaningful shift happens when charge capture, documentation, physician intent, and authorization tracking work as a connected system. Each informing the next, with nothing lost in handoff.
“Modern workflows don’t replace clinical judgment or billing expertise. They just remove the friction between the two,” Terry said.
For proton centers operating with thinner margins, smaller teams, and higher per-treatment stakes, that kind of infrastructure isn’t optional. It’s the difference between a practice positioned to grow and one that stays perpetually behind.
Fuse Oncology builds end-to-end workflow solutions for radiation oncology, including AI-powered charge capture review (S!GNAL) and clinical documentation automation (FuseDocs). Founded out of Cone Health’s radiation oncology department, Fuse supports health systems across the United States.
