Understanding Oncology Medical Billing: Prominent Challenges & Essential Tips

Oncology is one of the most drawn-out processes because of its complicated nature. As an oncologist, you must take care of thorough medical treatment documentation and timely follow-up on the submitted claims. Whenever a phase of therapy ends, you must ensure an accurate medical billing and coding process for your oncology practice to receive timely compensation for your services. 

Apart from the complexity of the entire process, the compliance rules and regulations keep on updating regularly in oncology billing. Even when there is expertise on healthcare providers’ end, all the coding rules and regulations must be accurately followed, so that you get paid by insurance companies. The reimbursement rates for oncology practices are comparatively higher, which necessitates the need to be more vigilant.  

In this blog post, let’s give you a deep understanding of what oncology billing is and what are the challenges faced. We will also discuss some best practices in oncology billing and how getting oncology medical billing services from an expert provider can transform your revenue cycle.  

What is Oncology Billing?  

Oncology billing is a complex process which includes accurate coding and documentation of various healthcare services. To ensure that healthcare facilities receive right and timely reimbursement for imparting cancer treatment services, the process must be smooth. In the entire procedure, various challenges emerge which includes costly diagnostic tests, radiation therapy, and chemotherapy.   

It is very important to thoroughly understand all the billing codes and procedures. Along with that, there must be a strong commitment to stay updated with all the advancements in rules, regulations, and policies of insurance providers.  

To navigate in this complex world of oncology billing, the patients and healthcare providers rely on expert oncology medical billing services. 

Workflow Step in Oncology Medical Billing  

At first, when you get involved in Oncology Medical Billing Services, it might seem very difficult and exhausting.  

To approach the process of Oncology medical billing, it is very important to be familiar with workflow steps involved. 

Step 1:  Verifying Insurance Eligibility 

The foremost step is to verify the coverage of insurance and get pre-authorization. It will assist you in covering the patient’s health plans, treatments, and possible payments. You must ensure accurate patient records and changes in insurance.  

Step 2: Charge Capture 

Make sure that you document all the oncology medical billing services accurately. It must include all the CPT, ICD codes, and the modifiers. In this step, you must take care of timely charge capture and prevent any missed or lost payments so that the revenue loss can be prevented.  

Step 3: Final Claims Submission  

In this step, all the medical claims prepared are presented to the insurance providers to get reimbursed. Before submission, you must confirm that all the claims are correct, complete, and are delivered on time. This will help in avoiding denials and in case any denials emerge, review them carefully.   

Step 4: Receiving Reimbursements  

When the medical claim is accurately processed and submitted to the insurance provider, your oncology practice will be reimbursed for the services delivered. Here you need to properly monitor all the expenses, address every outstanding balance, and maintain financial records free of any errors. Also, make sure that you stay updated about the changes in reimbursement rates.  

Step 5: Maintain Proper Data Reports 

The process doesn’t end with getting reimbursed. You must record all the critical metrics that you found in the entire oncology billing process. It includes proper tracking of revenue, AR management, resolving denials and rejections. When you have organized data, it will help you know the areas of improvement and create a smooth oncology billing process for your healthcare practice.  

Major Challenges in Oncology Medical Billing  

Here are the major challenges that arise in Oncology Medical Billing Services and hamper the entire process: 

Erroneous and Unfinished Claims 

One of the biggest problems in the entire oncology billing process, which gives rise to various other problems, is the submission of claims that have errors in them. It is a problem of all the medical specialties in the healthcare landscape. There are various reasons for an unfinished claim. Make sure you include the patient’s full name, gender, date of birth, and medical emergency which falls under oncology medical billing services. 

Not Using the Correct Codes 

Unlike other medical specialties, oncology facilities include various coding standards that must be considered. It is a difficult situation for coders and billers to find the appropriate code according to the medical situation. To get the medical claim approved by the insurance providers and receive reimbursements for the services delivered, it is important to use the right codes. If there is even a minor issue with the assigning of codes, the entire claim will be denied, and the process must be repeated.  

Not Able to Maintain Compliance with Current Coding Guidelines 

When an oncology practice is not able to maintain compliance with the ever-evolving coding guidelines, it poses a further challenge for them. It is extremely crucial to adhere to the various industry laws and laws of government. If there is any compromise with the codes or any sort of faulty coding, it can lead to fines or any other legal action.  

Ways to Eliminate Oncology Billing Challenges 

It is not an easy task to simplify the entire process of Oncology billing from beginning to end. You will need a team of professionals like Eminence RCM who provide reliable oncology medical billing services. To eliminate the challenge, you need to take care of the following: 

Thoroughly Understanding the Entire Coding Process  

As a healthcare professional, you can improve your understanding of oncology medical billing and coding in different seminars, by reading industry updates, or by training with organizations like AAPC. There are different certification programs offered by AAPC which are helpful to enhance your coding accuracy.   

Choosing a team of medical billing professionals like Eminence RCM and working closely with them will be quite helpful. They can give you guidance on best practices, identify various areas of improvement, and offer support whenever required. 

Properly Verify Insurance Coverage 

It is important to understand the concept of patient benefits. For that, you can directly contact the insurance company or consider the online verification process. It will not only help you understand the patient benefits, but also co-pays and deductibles. Along with that, you’ll also be able to avoid any surprises or unexpected expenses. If you face any issues, try to solve them before the patient visits. Properly verifying health coverage will greatly reduce the chances of denials.  

Ensure Accurate Documentation  

It is an obvious fact in medical billing that incorrect or incomplete patient information will lead to payment delays or even denials. The result is the loss of revenue for your oncology practice. Therefore, your primary focus should be to ensure precise documentation with the patient’s proper medical history.  

Your medical professionals should be able to record all the diagnosis, various treatment plans, and procedures. When your expert oncology medical billing services, like Eminence RCM, confirm that all the data is correct, healthcare facilities will be able to reduce claim rejections which will result in a better cash flow.  

Submission of Claims on Time  

Even if the claim is perfectly fine and is not submitted within time, there are high chances of payment delays and denials. All the insurance providers have very strict deadlines when it comes to accepting medical claims. If you miss the timeline, it can result in major loss of income for your healthcare practice.  

It is not very difficult for the healthcare providers to ensure the timely submission of claims. You must have a proper tracking system and monitor your claim submissions with scrutiny. The result will be a reduced administrative burden and less monetary strain in your healthcare practice and the entire process will be streamlined.  

It’s Time to Hire a Professional Medical Billing Company: Eminence RCM 

The process of Oncology medical billing is quite intricate, and it can get quite complex to manage everything in-house along with taking care of the patients. In this scenario, outsourcing to a professional medical coding and billing company like Eminence RCM is the best option. Their expert oncology medical billing services will help you improve your revenue cycle management and you’ll be able to stay updated with the latest billing regulations and technology. All aspects of your revenue cycle will be effectively handled, and you will be fairly reimbursed for all the oncology services provided in your healthcare practice.