The best way to stop medical practices from slipping into sinkholes is not yet available to oncology practices. This is a result of recent changes made to the medical billing processes. Outsourcing your oncology medical billing can help defend your practice from dangers that could negatively impact your company’s capacity to get reimbursement.
Oncology medical billing codes and compliance guidelines undergo a number of revisions periodically. This presents several difficulties for the professional staff, such as their inexperience with the latest codes for developing or cutting-edge technologies. Lower reimbursements may occur from claim denials due to a lack of understanding or inadequate knowledge of the procedure and diagnostic codes.
Oncology engages with other specialists in addition to those who perform the surgeries or treatments. To deliver top-notch patient care, oncologists must also deal with post-operative trauma, mental health, and other medical specialties. Every year, codes for oncology medical billing are revised to reflect new policies, regulations, and insurance payer requirements. Medical billing experts should make sure that the billing and coding are precise. Revenues and payments for rendered services are impacted when accurate and up-to-date codes are not reported.
What Is Oncology Coding?
Oncology coding converts cancer patient files into the standard code insurance companies require for oncology clinics or facilities. Oncology coders get their information from recorded sources such as radiologic data, laboratory results, and transcriptions of oncologists’ notes.
This administrative facet of the oncology practice investigates and assesses the information necessary for insurer payment. It examines patient files that include information on cancer diagnoses, therapies, practices, and institutions.
Coders translate patient data into numeric or alphanumeric codes after arranging and evaluating them for consistency issues. Oncology billers use these codes to produce the claims they will send to insurance companies. In order to minimize claim denials and increase payment collection from payers, oncology coders make sure that they apply medical codes accurately.
What Are the Codes Used in Oncology Medical Billing?
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), current procedural terminology (CPT), and Healthcare Common Procedure Coding System are the three categories into which the codes used in oncology medical billing and coding are divided (HCPCS).
These codes are a component of the Health Insurance Portability and Accountability Act’s cancer billing regulations (HIPAA). Effective in 1996, HIPAA enforces standards for health information.
HIPAA guidelines must be followed by all healthcare professionals, including oncology specialists. Failure to do so may result in massive fines per type of violation each year. Jail sentences are another possibility for criminal penalties.
How to Become an Oncology Coder?
A nationally recognized medical coding certification and an associate’s degree or equivalent are prerequisites for becoming an oncology coder. The Certified Hematology and Oncology Coder is one such certification (CHONC).
The CHONC certification, offered by the American Academy of Professional Coders (AAPC), testifies to an individual’s hematology and oncology coding proficiency. These include the application of chemotherapy, hydration services, and diagnostic and therapeutic administration.
Some oncology practices use individuals who have extra coding skills, such as the Certified Coding Specialist (CCS) or the Certified Professional Coder (CPC). The American Health Information Management Association offers the CCS certificate, while AAPC grants the CPC.
These two qualifications differ from CHONC in that the latter specializes in oncology medical billing while the former deals with general medical coding.
Being a strong communicator and planner and knowing how to use word processing, spreadsheets, and presentation programs are essential for an oncology coder.
What are Oncology Medical billing and Coding Challenges?
Here are a few challenges with oncology coding:
Choosing the Proper Codes
In contrast to other medical specialties, oncology practices have varied coding standards. Finding the appropriate codes to use presents special difficulties for coders. In any case, they must utilize the appropriate codes in order for insurance providers to approve the claims and reimburse oncology practitioners.
On the other hand, an insurance company won’t approve a claim if the codes are off. Claims may be disputed repeatedly until the biller, and the payer agreed.
For example, giving chemotherapy to a patient has various associated codes. Each code reflects a distinct level of severity. If the oncology coder is unable to determine the exact severity, they will most likely use an inaccurate code. This will result in claim denial and payment delay.
Insurers reject certain oncology medical billing claims because of a lack of thoroughness. Coding professionals utilize codes for procedures almost identical to one another while processing claims.
When these claims are provided without further details to substantiate each code used, the payer can reject the documentation or question the oncology practice before approving the claims. This scenario causes money collection delays.
Oncology coders must be very specific during coding. Understanding the language used by oncologists is important for improving accuracy in their reporting.
The AAPC emphasizes the importance of knowledge in all aspects of ICD-10-CM coding. For effective Oncology coding, medical coders should understand exactly what the patient, doctor, and payer are saying.
Here are some examples of terms that influence oncology medical billing and coding:
When coding for malignancy, first determine if the condition is “active” or “has a history of.” The following terms will assist coders in determining the status:
Current: Active treatment is being used to cure or relieve cancer symptoms.
Adjuvant: Additional treatment options include hormone therapy, radiation therapy, and chemotherapy.
History: Cancer-free state with no disease evidence and no treatment.
Debulked: means partially eliminated.
Eradicated/Deleted: Completely removed.
Furthermore, the AAPC advises coders to avoid using unclear terminology in their documentation when coding diagnoses. The phrases “suspected,” “questionable,” “likely,” “possible,” “presumed,” and “consistent with” are among them. They are subjective and do not meet the diagnostic criteria.
Ensuring Compliance with the Most Recent Coding Rules
Another problem that oncology facilities encounter is maximizing revenue while keeping compliant with industry and regulatory laws.
Incorrect Oncology billing and coding owing to out-of-date or invalid codes can result in penalties or criminal prosecution. Inaccuracies, whether intentional or unintentional, will result in claim denials.
How can NEO MD Medical Billing look after their associated Oncology Medical Billing providers?
When it comes to Oncology Billing, NEO MD partners have access to a variety of services. We provide HIPAA-compliant Oncology Medical Billing and Coding. We employ cutting-edge equipment and technology to provide our clients with high-quality services. NEO MD is proud of our Oncology services since we optimize the return on claims while minimizing the risk of errors. Specialized software, billing experts, programmers, and qualified professionals create more substantial revenues than the market.
When compared to other revenue cycle management companies, NEO MD’s Oncology Medical billing services are frequently rated as among the finest in the US. NEO MD also offers medical billing services for small practices, medium-sized and large clinics, respectively. In addition, we provide customized billing services to medical practitioners in all 50 states. Furthermore, the healthcare practices might locate the top Medical Billing company near me to acquire our services.
What Makes NEO MD the Best Revenue Cycle Management Company?
NEOMD stood best among competitor’s Revenue Cycle Management companies due to the following cores;
- Improve RCM system efficiency with a robust credentialing team.
- Our experts work hard to reduce your front-end denials by 20%.
- Increase the accuracy of fees and collection.
- Refunds adjustment and Payment posting to improve the cash flow.
- Out of Network Negotiations.
- Provide fortnightly financial and practice overviews.
- Use the latest technology and tools.
- Offer internal audits to uncover loopholes
- Provide Oncology Medical Billing and collection services that are of high quality and error-free.
- We have consistently increased the collection rate for our clients because of the faster processing of accounts receivable and on-time follow-up.
- Offer Services that are easily scalable at all times.
Let’s Schedule a Demo to learn more about how we can improve your medical practice management. Get us at! (firstname.lastname@example.org) or (929) 502-3636).