Billing for oncology services is one of the most complex arenas within medical revenue cycle management. Given oncology deals with high-cost drugs and multi-stage complex treatments, which are further governed by strict payer specific guidelines, even the most minor billing errors can lead to claim delays and denials.
One of the most common types of error happens due to coding inaccuracies, whereby the coder fails to capture the value of the service rendered by the practitioner. As per industry experts, coding errors have caused oncologists to face $28 billion in improperly paid claims.
This is where expert oncology billing services play a vital role. These professionals have certified coding expertise which enables them to assign the relevant codes to services rendered effectively.
Why Coding Accuracy is Critical in Oncology Billing
Maintaining coding accuracy in oncology billing is important to ensure proper reimbursement for practitioners for their services rendered. It not only helps capture the value of the services rendered, but also allows reduce need for administrative rework. This helps maintain a steady cash flow of oncologists.
Common Medical Codes Used in Oncology Billing
Various types of medical codes are referred to in oncology billing. Some of the most frequently used ones will be highlighted down below:
Code type | Code and description |
CPT | 96413: This code is used to denote chemotherapy IV infusion, initial, up to 1 hour. |
| 88305: This code refers to surgical pathology exams, like tissue biopsy. |
ICD-10 | C61: This is used for malignant neoplasm of prostate. |
| C56.9: This indicates an ovarian malignant neoplasm (unspecified). |
HCPCS | J9035: This refers to an injection known as bevacizumab, 10 mg. |
| J9000: This code refers to an injection namely doxorubicin hydrochloride, 10 mg |
An expert oncology billing company has in-depth understanding of these coding requirements, which ensures billing accuracy for oncologists.
Key Challenges in Oncology Coding
Coding errors in billing for oncology services happen due to various reasons.
- Ongoing improvements in cancer care, including immunotherapies have made it necessary for regulatory bodies to make annual updates to the existing codes to keep uo with the demand. Failure to stay aware of these updates leads to inaccuracies in HCPCS and CPT codes.
- Accurate coding relies on precise clinical documentation. Challenges arise when documentation is incomplete regarding cancer staging and metastasis sites.
- Oncology involves numerous modifiers. For example, 25 is used for distinct service, -59 for separate sites and so on. Missing or incorrect modifiers, along with unbundled codes, often result in claim denials.
- Treatments, particularly breast cancer, can last for years. Correctly coding over time requires precise tracking of the patient's status like active vs. remission and the specific, shifting regimens.
- Incorrect documentation of medication wastage, particularly with partial-vial usage of expensive chemotherapy drugs, often leads to revenue loss.
- Radiation oncology involves complex, multi-month workflows (30-50 codes) that are highly susceptible to clerical errors, such as duplicate charges or incorrect dates.
This is where professional oncology billing services play a vital role. They not only understand the depth of these problems but have proper strategies in place to ensure strict adherence to payer specific coding guidelines.
How Oncology Billing Services Ensure Coding Accuracy
Expert billing companies have necessary resources and mean in place to ensure coding accuracy in all claims. For example, they have AAPC and AHIMA certified coders which ensure they are updated on coding regulations. They also have advanced coding software in place which helps reduce chances of manual errors.
Furthermore, these companies provide ongoing education to coders to make sure they are updated on annual coding changes, evolving payer requirements, and so on. They even conduct multi-layer audits throughout the billing process. For example, pre-claim submission reviews help identify errors before submission. Lastly, they thoroughly review clinical documentation to identify any gaps that can be reflected in coding, and thus ensure billing accuracy,
Best Practices for Maintaining Oncology Coding Accuracy
- Standardize documentation workflows
- Use coding checklists for chemotherapy and radiation
- Implement real-time eligibility and authorization checks
- Maintain clear communication between clinicians and coders
- Hire expert coders to ensure adhere to payer specific coding guidelines
Streamline Coding Accuracy with the Right Partner
Outsourcing billing services is becoming immensely popular among providers. One of the most common reasons is their cost-effectiveness. For example, oncology billing specialists like SunKnowledge, charge only $7 per hour for their services. This allows them to reduce the operational cost of oncologists.
Additionally, the plethora of coding expertise these companies carry; is insurmountable. For example, these companies have AAPC and AHIMA certified medical coders which indicate their thorough knowledge of medical coding requirements. This is further reflected in their high coding accuracy rate in clean claims, and the high rate of first pass claim collection. For example, SunKnowledge has a track record of 97% first pass claim collection rate.
Furthermore, it is noteworthy to mention here that these companies offer end-to-end revenue cycle management solutions. For example, RCM solution providers manage 70-75 claims per day depending on client demand. This is again an added bonus.
If you are also facing issues with ensuring coding accuracy and maintaining a steady cash flow, then consider outsourcing oncology billing services.
