Greater efficiency in medical billing leads to greater reimbursements. The same holds true for oncology where although care is the topmost priority of any physician, the practice needs to be in a financially stable form too. From billing and coding, processing of claims, and chasing patients for unpaid bills, the oncology billing and coding services department need to be on their feet all the time.
Oncology constantly undergoes technological and procedural updates (guidelines provided by the American Society of Clinical Oncology). Though there is little room for errors or inefficiencies, some as those mentioned below do occur.
Hence, it is essential for the oncology billing and coding team to stay abreast with the revisions related to codes, documentation, and revenue cycle management (RCM).
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Numerous errors are made by coders if they are not updated with the recurrent changes. Failure to capture the CPT codes along with usage of incorrect modifiers can lose a great deal of revenue.
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No framework exists for recording the claims in a timely manner. It is imperative to document and file the claims within the schedule. Usually, the filing limit for most insurance payers is 30 days; beyond this, it could be denied for erroneous filing.
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Medical coders are also sometimes not well versed with bone marrow procedures, blood transfusions, and transplantations leading to a loss of revenue. Reading and understanding the EoB (Explanation of Benefits) is vital (understanding what and why of the payments) as well. Under-coding or over-coding can lead to revenue losses too.
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Neglecting codes related to equipment used in oncology (eg. radiation oncology) can lead to incorrect medical billing and coding. Continuous training and awareness should be the norm for oncology billers and coders (awareness of the latest codes and modifiers - AMA frequently updates the oncology codes, office visit codes, in-patient visit codes, etc.).
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Many coders tend to code as per the diagnosis only, wherein it must be coded as per the decision taken.
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Ensuring insurance verification of cancer patients before the treatment is becoming increasingly important due to new rules and regulations and high-cost cancer therapies. Missing out on this step can cause a great deal of payment issues, especially co-pays.
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Another error often overlooked leading to cash on the table is not reviewing reports or following up on the unpaid claims. Claim filing must be based on automated processes along with a robust system which supports billing and administration.
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Not checking the clearinghouse reports is another error committed by the oncology billing and coding team, predominantly if there are new reports coming in. Another error often overlooked is the non-compliance of oncology billing guidelines leading to a tremendous amount of reimbursements not accrued.
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Usually, on the part of the physician, errors can occur when he tends to leave out documenting the negative findings they have incurred during tests and examinations. The physician must ensure that along with the positive, the negative findings too are included in the examination level as costs have been incurred on these tests and examinations as well.
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Errors also occur when drug units listed are incorrect. This usually occurs as HCPCS has set different codes for specific billing units, but the drugs are available as single or multiple-dose vials. Hence, to get appropriate reimbursements, it is imperative to document this appropriately.
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The place of service and type of service are interconnected. Sometimes, errors occur if the place of service is not aptly mentioned. For a comprehensive oncology billing practice, these details must not be ignored.
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Especially under radiation oncology, documentation details that are sometimes missing are: the initial treatment plan or the radiation order, the physician's signature or attestation, radiation treatment records and/or plan, physician instructions for the specific radiation treatment and its management, and/or the dispensation of the billed IMRT delivery.
Time is Money, and is especially indispensable in the medical discipline. The team at Medical Billers and Coders (MBC) are specialists in the field of radiology and oncology-related medical billing services, and ensure timely services with no money being left on the table.
Since cancer treatment is very complex, the documentation and tracking of tests, diagnosis, and treatment, along with the required medical billing and coding, it gets very critical to obtain reimbursements at each stage.
Hence, the team at Medical Billers and Coders are tech-savvy, aware of the constant changing guidelines and rules, and provides an error and denial-free service to their customers nationwide.
To know more about our Oncology billing and coding services, contact us at info@medicalbillersandcoders.com/888-357-3226.
Published By - Medical Billers and Coders
Published Date - Dec-12-2016
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