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  • Insurance EligibilityInsurance EligibilityA pivotal part of medical billing processes, insurance eligibility is of paramount.
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Did you know oncology medical billing is currently considered one of the most crucial aspects of healthcare practice? That is because It handles the patient bills for probably the most significant health problem: cancer. This blog will provide a comprehensive guide to medical billing for oncology services.

We have covered the importance of accurate bills for it as well. The blog also discussed its challenges and how you can streamline it. Continue reading further to find out how you can upscale your oncology billing processes.  

Oncology Medical Billing

What Is Oncology Medical Billing?

Oncology medical billing is a process implemented by healthcare providers to generate medical bills for cancer treatment services. These services are available to patients who are later billed by submitting reimbursement claims to their insurance providers.

In this way, you can receive the applicable reimbursements for your oncology services, such as chemotherapy, diagnostic tests, and radiation therapy. You must be well-versed with the relevant medical terminologies and oncology billing codes to implement effective medical billing.

Importance of Accurate Billing in Oncology Practices

Medical billing processes should generate accurate bills, especially for oncology services. Accurate billing has financial benefits for oncology practices. Apart from that, it is also important for patient care. By doing this, you can ensure that there is no unnecessary delay or complication in providing services to your patients.

You are also able to afford the high cost of equipment and other resources for cancer care. Moreover, accurate bills prevent additional administrative burdens from piling up on you. They also keep your patients satisfied with the quality of care they receive.

Precise and complete medical bills enable value-based care. Invalid documents and coding errors can lead to claim denials and underpayments by insurance companies. However, due to accurate billing, they are extremely rare and have no effect on your financial sustainability.

Oncology Medical Billing

A Step-By-Step Guide to Oncology Medical Billing

Oncology medical billing is usually implemented in the form of a workflow by healthcare providers. You can make your medical billing more efficient by following this workflow and executing its steps.

It comprises a wide range of important steps like capturing medical charges. We will also be looking at receiving payments and reporting the relevant data and analytics.

1. Capturing Medical Charges

After verification, you can capture the medical charges of your oncology services that have to be provided to eligible patients. This step involves documenting those services by assigning the relevant CPT and ICD codes to them.

You also have to record accurate charges for each service as they will be needed later while generating medical bills. Healthcare providers must ensure that they timely capture the charges of their oncology services as overdue payments can cause revenue loss.

2. Receiving Payments

This step signals nearing the completion of your oncology medical billing services. At this stage, the work is completed on your end and you have to wait for insurance providers to approve your reimbursement claims.

You are likely to receive the pending compensation for your cancer treatments if your claims are complete. On the other side, your claims may also be denied by the insurers for several reasons. An ideal scenario for you is the approval of your claims without any denials or appeals.

You can maximize them by accurately maintaining your financial records and monitoring other expenses. This enables you to stay updated on any changes in reimbursement claims so that you can effortlessly receive your healthcare payments.

3. Reporting and Analytics

The final step in oncology medical billing is reporting and analytics. It is an optional one and involves the usage of the details recorded from a particular oncology process. You can analyze those details by tracking your revenue and accounts receivable.

Your analysis can enable you to gain informational insights and identify areas of improvement within your oncology medical billing. In this way, you can modify your current billing practices into an optimized version that delivers better financial results for your healthcare organization.

Challenges of Oncology Medical Billing

Hospitals may find oncology medical billing challenging for a lot of reasons. It can also get complex for you if you do not pay attention to their oncology medical coding. Those codes undergo frequent changes, and you may struggle to keep up. You may also not understand them enough, which can lead you to under-code them.

This can cause billing errors and result in claim denials. This way, you can end up with significant revenue loss. Furthermore, misunderstandings can also cause insurance companies to delay their payment releases. Such delays can cause frustration among patients and healthcare providers.

This is why your medical billers should stay updated on the coding changes. They must also be trained with the latest coding practices. These measures can ensure billing accuracy and prevent errors. Hospitals should also track their billing processes and oncology services. It can streamline your medical billing.

Commonly Used Oncology Billing Codes

There are various billing codes assigned to oncology procedures and services. Here is a list of the major ones involved in cancer treatment.

. Code 77332

This is a CPT code assigned whenever the devices and equipment for intermediate treatment are used. As an example, you may use designs and construction blocks for several port blocks. There are some pre-designed blocks, like the midline spinal cord blocks.

In addition, you may also have to treat beam splitter blocks and the special multi-user bolus. You have to use the 77332 code for every service provided to treat these health cases.

. Code 77334

This is another CPT code that you have to assign for complicated treatment devices. They can be used for construction and design blocks. Similar equipment includes bolus that can either be customized or single-used.

An example is a wax mold that you can confine to specific body parts. Compensators and low alloys are used to make those customized blocks. Apart from them, the production of other blocks includes wedges, molds, and casts.

. Code 77336

Hospitals assign the code 77336 to their medical services, which include radiation. You can also assign it to continuous physical consultation. It should include an assessment of various oncology treatment parameters.

You must also conduct quality assurance for the delivery of the relevant dosage. Often, several forms of patient documentation are involved. Those documents include key details like the radiation oncologists involved, therapy, and treatment cycles.

. Code 77370

Special radiation and physical consultation are based on this CPT code. The health issues relevant to these consultations are addressed by oncologists using it. Certain exceptional circumstances can also arise during radiation therapy.

You can assign the code 77370 under those circumstances as well. You have to prepare a detailed report on the specific health problem to assign this code. It must be endorsed by a reputable oncologist with a proper description.

. CPT Code 77387

Only the Hospital Outpatient Prospective Payment System is supposed to use this code. It is assigned whenever you have to localize a target volume in radiation treatment. You may also assign the code 77387 for intrafraction tracking. Each procedure conducted for radiation treatment should be reported frequently, along with its delivery code.

This should be done at least once in every treatment session. Keep in mind that these CPT codes are not affiliated with any doctor’s consultation. However, you can consider them for the technical aspects of the relevant oncology treatment.

Best Practices of Oncology Medical Billing

There are numerous medical billing best practices that can be implemented to optimize oncology billing. The best ones are even capable enough to transform your oncology billing and coding process and maximize the revenue flow.

You can also implement certain practices that ensure accurate documentation. Other practices include hiring third-party services, implementing automated software, and many more.

1. Ensuring Accurate Documentation

Healthcare providers can also optimize their medical oncology billing by ensuring that their reimbursement and billing documents are accurate and complete. This practice prevents delays in the reimbursement process and reduces the likelihood of the insurers denying your claims.

You can set up an electronic health record system to accurately record complete cancer records of your patients. These records can involve procedures like chemotherapy and radiology, along with the appropriate treatment plans and diagnoses.

In addition, medical practitioners should monitor the medical codes assigned to their cancer procedures. In this way, they can include accurate details about those codes in their reimbursement claims. These methods can lead to instant reimbursements for their hospitals.

2. Automated Oncology Software

You can also implement automated software to bill your oncology services. The prevalent oncology billing software in the medical sector primarily includes oncology practice management platforms that work wholly between healthcare providers and patients.

These platforms utilize cloud-based technologies to automate your workflow invoicing and minimize manual errors. In this way, you can prioritize patient care instead of the repetitive tasks performed by automated software.

Most of these software have a user-friendly and intuitive interface that comes with customizable dashboards. You can work on these dashboards to monitor your healthcare metrics, like pending medical bills and overdue reimbursement claims.

3. Hiring Third-Party Medical Services

Furthermore, you can ease the challenges of your medical oncology billing services by hiring third-party services. They can especially be beneficial for you if you have a small-scale hospital or clinic with limited resources.

In this case, you can outsource oncology medical billing operations for your treatments and procedures. By doing this, medical practitioners ensure that their operations are being handled by expert and professional oncology billers.

You can trust them to skillfully follow the oncology billing guidelines and standards set in the healthcare sector. Third-party services can also easily handle your medical billing and execute important steps like submitting reimbursement claims and following up on them.

Tips for Streamlining Oncology Medical Billing

There are certain steps that you can take to streamline your oncology medical billing. We have covered some of those steps in detail below:

1. Understand Medical Codes 

You should understand the medical codes involved in oncology medical billing. You can do that by reading major publications and attending seminars. Most of the billing professionals undergo training. Organizations like the American Academy of Professional Coders provide training.

These organizations provide certification programs for billers and coders. They can enhance their skills and accuracy by attending those programs.

2. Verify Patient Insurance Eligibility

Hospitals must directly contact the insurance company of their patients. They can also use an online verification system. These measures are important for the insurance eligibility verification of their patients. By doing this, you can understand the co-pays, benefits, and deductibles of your patients. You can also avoid any unexpected actions or expenses from them.

This step prevents payment delays and claim denials. In case of invalid patient insurance details, your reimbursement claims may get refused. And it will take a lot of time to fix that. Hospitals should confirm the health benefits of their patients as soon as possible. This way, your billers can ensure that the details are accurate and updated.

3. Timely Claims Submission 

Your claims may get denied, or the insurers might delay your payments due to late claims submission. You usually have to follow the strict deadlines of insurance companies. They only accept reimbursement claims under a specific timeframe. You might have to face revenue loss if you miss these targets. 

Hospitals can implement a claim tracking system. Such systems are efficient in ensuring that insurers have accepted claims. You can also use them to monitor submission deadlines. This way, you can get reimbursed timely for your medical services.

4. Technology 

Certain technological solutions in the medical field can improve your oncology medical billing. Electronic Health Records can enable you to access and manage your patients’ information. You can also use them to submit claims and verify the insurance coverage of your patients. 

There is software as well that helps with claim submission and payment posting. It saves you time that you can allocate to providing quality care. With oncology medical billing solutions for digital charge capture, you can prevent missed or lost charges.

Benefits of Outsourcing Oncology Medical Billing Services

Outsourcing your oncology billing services to healthcare practice has a lot of benefits. Here is a list of a few of those benefits:

1. More Control

Many healthcare organizations fear they will lose control over their billing operations if they outsource them. At the same time, they can be fully in the driving seat if they implement this. The outsourced company is trained to manage your time-consuming billing tasks. They can deal with the burdensome procedures that come with oncology billing.

You just have to watch them from afar and review their insightful reports. The reports give you a clear picture of their performance. You can use them to determine the impact of an outsourcing company on your oncology billing. This way, hospitals are also able to freely discuss any issues with them. As a result, outsourcing companies can fix those issues in advance.

2. Better Oncology Billing

An in-house billing staff poses a lot of challenges for a healthcare organization. The management is highly dependent on that staff. Any minor discrepancy can affect your overall day-to-day billing operations. However, by outsourcing your oncology services, you do not have to deal with such challenges.

There is a specific team of expert professionals who can process your medical claims. You can also access their vast knowledge base. They can easily handle your billing tasks, and you do not have to experience any revenue loss.

3. Increase in Healthcare Revenue

There are mostly detailed and high-cost services in oncology billing. This means that even a minor claim that is denied can lose a lot of revenue. However, an outsourcing company means that all such problems can easily be identified. The billing professionals can also rectify them so you do not face any such claim denials.

Hospitals are also able to save a lot of money through outsourcing. An outsourcing company only charges a small percentage of your revenue. It is nothing compared to the losses that can happen with in-house billing. Therefore, outsourcing decreases your operational cost and upscales your overall revenue.

The Bottom Line

This blog explored the process of oncology medical billing and examined the importance of accurate bills. We also saw that oncology billing can get challenging if you are not careful. For that, we uncovered the measures that can streamline it.

There was also a mention of the benefits of outsourcing oncology billing. Health Quest Billing has an experienced team of oncology billers with whom you can enjoy those benefits. Contact us today to learn more about the oncology billing services we have in store for you.

Contact Us For Oncology Medical Billing

Ready to upscale your Oncology Medical Billing Process and Boost your Revenue? Schedule an appointment with Health Quest Billing today and let our experts guide you towards a more efficient and profitable billing future.

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Frequently Asked Questions (FAQs)

An oncologist is also called a cancer specialist. A medical oncologist uses medication to treat cancer. It includes immunotherapy, chemotherapy, and targeted therapy.

The three types of oncology specialists include medical oncologists. Another type is radiation oncologists, who use ionizing radiation to treat cancer. The other type of oncology is surgical oncology.

Hematology is a medical field that treats blood problems and diseases. It involves bone marrow, blood cells, and lymph nodes. Oncology is a different medical field that treats cancer.

The medical oncology unit is based on inpatient oncology. It is considered as a stepdown unit that brings cancer patients together. It provides all of them with specialized nursing care.

An example of oncology is medical oncology. It uses hormone therapy, chemotherapy, and relevant medical procedures to treat cancer.