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Adapting to Evolving Trends and Billing Practices in Oncology Medical Billing

January 02, 2014

Dental medicine is often seen as a highly profitable healthcare stream with guaranteed long term returns. However, what most people fail to understand is the amount of complex planning and execution that goes into acquiring and maintaining that sustained level of profitability. Dental reimbursement rates are generally poorer than medical reimbursement rates. Given that, ensuring continual claim settlement and reduced claim rejection requires a dental medical practitioner to focus on final details of dental billing. Whether your dental medical billing is in-house or outsourced, there are certain steps that you can take to ensure improved medical insurance reimbursement ratio –

  • Billing for specific modalities are more frequent than others and therefore coding changes in them are most crucial for oncology medical billing. These modalities include EBRT or External Beam Radio Therapy (EBRT), IMRT and non-IMRT, SBRT or Stereotactic Body Radio, Therapy BT or Brachy-therapy and PT or Proton therapy.
  • There has been a consistent rise in billing of IMRT and other radiation therapies since the introduction of their separate codes in early 2000s. Despite being expensive, these are preferred procedures and Medicare, Medicaid or other private insurance carriers process the claims for radiation therapy at a fast rate.
  • Payer restrictions on oncology drugs are increasing due to abuse related audits and many oncologists are facing high rate of payer denials for medical billing services of oncology drugs. Medical insurance carriers are growing increasingly cautious about reimbursing oncology drugs claims and therefore the denial ratio is mounting.
  • Oncology practitioners are outsourcing chemotherapy coding and billing. Chemotherapy and non-chemotherapy infusion, in addition to radiotherapy is coded with great care and is also the biggest source of revenue for an Oncology practitioner. Therefore, as a rising trend, this coding and billing practice is getting outsourced to capture frequent changes and avoid any discrepancies.
  • Ignorance of payers towards technological advancements and changes in oncology treatments makes oncology medical billing an even more difficult task for oncology practitioners and practice managers. This means clarity in claim filing and updating your payer about technological requirements becomes part of your responsibility as a claimant.
  • Commonly recognized oncology medical billing errors include misuse of modifiers in service identification and improper documentation related to treatment conducted. These lead to frequent denials and can only be checked by adopting stringent billing practices.
  • Pre-authorization requisite for cancer treatments is frequently being mandated by insurance carriers for them to expeditiously complete the claim settlement process. Radiation, oncology drugs and chemo/non-chemo infusions are especially to be pre-authorized by insurers before the oncology practitioners can administer and claim for the same.

Medicalbillersandcoders.com is a billing service provider that specializes in oncology billing and chemotherapy or radiotherapy coding. Our team of oncology coders and billers handle multiple chemotherapy administrations, code bundling and therapeutic infusion or injection reporting. Medicalbillersandcoders.com not only offers billing solutions that can enhance your profitability but can also improve your clinical experience and administrative performance. With a billing expert like medicabillersandcoders.com on board, you can focus on the care to be provided instead of administrative and financial aspects of cancer care.


Category : ACA / HIPAA / Reforms