Common Mistakes in Oncology Medical Billing and How to Avoid Them

Oncology medical billing

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.

It is very important to remember Oncology medical billing is a sensitive specialty by itself.

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.

How to Avoid Errors in Oncology Medical Billing?

Implement Automated Systems for Claims Processing

Using automated billing systems can significantly reduce errors in oncology medical billing. With the development of AI and RPA we can now verify procedure codes, diagnosis codes, units, and charges against the patient’s medical record automatically. With rule engines in place RPA can also cross-check to ensure that pre-authorizations are obtained for high-cost medications and procedures. Automation helps streamline the claims process, minimizing the risk of claim denials, underpayments, and compliance issues.

Use Software to Stay Up-to-Date with Coding Guidelines

Oncology medical billing is complex, with frequent updates to coding rules. Coding Automation software solutions are essential for staying current with these changes. These AI-based coding systems are regularly updated with the latest coding guidelines, ensuring that your billing remains accurate and compliant. Relying on tech to track changes in evaluation and management services, chemotherapy administration, and coding for complex treatment plans helps maximize reimbursement and avoid errors.

Conduct Regular Audits

Implementing an auditing process allows for proactive identification and correction of billing issues. Either have an internal audit team or you can also opt for Automated systems that can regularly audit a random sampling of oncology claims for accuracy and compliance with payer rules and internal policies. This is an important step to identify trends in errors, provide insights for process improvements, and reduce the likelihood of payers catching discrepancies. Continuous auditing ensures ongoing accuracy and compliance.

Outsource RCM to Oncology Billing Services providers

Outsourcing oncology medical billing to experts like AnnexMed can greatly help practices reduce errors and improve efficiency. We have over two decades of experience in handling the complexities of oncology billing. Our certified coders and billers stay current with the latest guidelines and payer rules. As your RCM partner, AnnexMed can help you achieve compliance, cost savings, and increased collections. Let your staff concentrate on what they do best, which is taking care of your patients. For a free consultation, please contact us.

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