Oncology medical billing can be tricky and challenging, particularly because it’s a complicated specialty. Errors are common when dealing with complex coding, expensive drugs, and frequent therapy modifications. And those errors can be expensive for your practice because denied claims affect cash flow. The complexities of oncology billing provide challenges for many practitioners. However, you want to proceed correctly and steer clear of typical traps. Continue reading to find out the most common errors and how to avoid them.
The Complex World of Oncology Medical Billing
Oncology medical billing can be complicated. As an oncology practice, you have to be extremely detail-oriented and up-to- date with complex coding.- Coding – You have to code each service, diagnosis, drug and supply accurately based on the physician’s documentation. Oncology uses special chemotherapy administration codes as well as codes for the actual antineoplastic drugs. You have to determine which revenue code to use for the location the treatment was provided. Was it in the clinic, infusion center or outpatient hospital? Each has its own set of rules.
- Prior authorizations – The majority of cancer services and treatments need the payer to grant pre-authorization. Before the patient receives therapy, you must acquire prior authorization, monitor its status, and ensure that all services are approved. Prior Auths frequently have very short timelines, therefore ongoing monitoring is required.
- Claims submission – You have to scrutinize claim details before submission to avoid denials. Ensure that ICD-10 diagnosis codes, CPT procedure codes, NDCs, units, and charges all match the prior authorization and are billed correctly.
- Patient Responsibility – In oncology medical billing Patient accountability can be quite significant due to the high cost of treatments and drugs. Verifying insurance benefits, figuring up patient cost shares, establishing payment plans if necessary, and collecting payments are all necessary. It’s crucial to exhibit sympathy for cancer patients because they frequently face financial challenges during their treatment.
Top 5 Common Oncology Medical Billing Mistakes
- Failing to Obtain Prior-Auth – This is no surprise. Many insurance companies require prior Authorization for oncology treatments like chemotherapy or radiation therapy. If you fail to obtain it, the insurance company can deny the claim, leaving your practice spending more time on retro auth. Double-check that prior auth is obtained for all applicable oncology services.
- Incorrect Coding – Accurately coding oncology claims is challenging, and mistakes can result in claims being rejected. Ensure that your coders are knowledgeable about the most recent coding standards. Make sure that the correct CPT treatment codes, HCPCS medication codes, and ICD diagnosis codes are applied.
- Missing Modifiers – Forget to append the correct modifiers to oncology CPT and HCPCS codes and your claims may be denied. Verify that modifiers like -25 (indicating distinct service), -59 (indicating separate anatomical site), and -RT and -LT (indicating right and left) are added when appropriate.
- Data Entry Errors – With so many codes and modifiers in oncology medical billing, data entry errors are common but easily avoided. Have your team check claim entries to catch mistakes. Consider automating parts of the data entry process to minimize human error.
- Not Appealing Denied Claims – Don’t assume all denied oncology claims should be written off. Many are denied in error and can be overturned on appeal. Review all denials carefully and appeal those for which you have proper documentation to support the treatment and charges. A successful appeal means getting paid for services already provided.
