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The oncology medical billing process is specifically limited to cancer treatments and procedures. Healthcare organizations implement it as a main operation since cancer is one of the most prominent medical issues in the world.
This blog will explore the main services implemented and important guidelines for this process. We will also analyze some drawbacks that can hinder its effective implementation. Continue reading further to learn how you can effectively implement it.
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What Is Oncology Medical Billing?
The translation of treatments requires specialized billing skills as the oncology billing codes of your services are complex. Their guidelines are constantly updated therefore clinics must adapt their billing processes and services to those changes.
Oncology Medical Billing Services
Various services are involved in implementing oncology medical billing like insurance eligibility verification and charge entry. It also comprises medical billing, accounts receivable, and denial management.
You have to effectively execute its services to increase the likelihood of insurance companies approving your claims and maximize reimbursements. Healthcare organizations can also customize these services according to their operational scale.
1. Insurance Eligibility Verification
Hospitals have to primarily verify patients in terms of their insurance eligibility. They implement it by validating the insurance policies and guidelines of insurance providers. The patients can also have specific plans for pre-authorization and referral requirements.
Moreover, you can use the conclusions derived from that verification to calculate your patients’ total deductible and copayments. This way, you can improve your cash flow with top-quality reimbursement claims and effective insurance eligibility.
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2. Charge Entry
After verification, you can implement charge entry in which you declare the total reimbursement required for your oncology treatments and procedures. Hospitals have to record reimbursements in the form of medical charges into their patients’ accounts.
They must ensure that their oncology billing staff extensively manages demographic entries and only enters accurate data into their system. These practices lead to accurate and complete records of patient demographics.
3. Medical Billing
There are several aspects of medical billing involved in the form of patient files. These files comprise cancer diagnoses, oncology test reports and tumor images. You have to comprehensively review them to be in a better position to generate medical bills.
Furthermore, billing can also be improved if you have verified insurance coverage and assigned medical codes. These steps are important as even small changes can cause overdue payments and claim denials. Such changes disrupt your healthcare workflow and add further billing issues.
4. Accounts Receivable
You must also extensively follow up on your accounts receivable even though it is a complex and time-consuming service. It requires hospitals to keep up with their reimbursement claims so that they can shorten their accounts receivable cycle.
In addition, healthcare organizations should also direct their billing staff to appeal underpaid and denied reimbursement claims as soon as possible. In this way, they can ensure timely processing of those claims, increasing their chances of reimbursing the insurers.
5. Denial Management
Claim denials are a major drawback for hospitals as they directly impact their rate of reimbursements and revenue flow. As a result, you should carefully track them to identify frequent trends and denial reasons.
You can utilize these trends and reasons to appeal the denied claims and solve their issues within the submission deadline. Moreover, you can also address the causative gaps of any missing information that is causing insurance providers to deny your claims.
6. Payment Posting
Hospitals can move on to the payment posting service after denial management. It identifies issues around payments and devises strategies to mitigate them. These issues mostly comprise doubts about the medical necessity and prior authorization of certain oncology treatments.
A specialized staff is assigned to handle payment posting. It comprehensively analyzes Explanation of Benefits and Enhanced Recovery After Surgery protocols. Their analysis ensures that the staff records payment details correctly and completely in patient accounts.
7. Provider Credentialing
Provider credentialing is an important service for oncology medical billing as it directly impacts the revenue cycle of healthcare organizations. It verifies how oncologists are associated with hospitals and clinics.
You can verify the credentials of your oncologists like skills, educational and experience documents. In addition, this service also enables your patients to reimburse you through the financial options of their insurance coverage.
Once those credentials are verified, insurance companies can swiftly process your overdue payments. The swift processing prevents claim denials, eventually leading to minimized revenue leakage and more referrals.
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Oncology Medical Billing Guidelines
There are certain oncology billing guidelines set in the healthcare sector for oncology medical billing. These guidelines facilitate optimizing medical billing for oncology. They primarily include accurate documentation, classification of medical codes and consistent updates in regulations.
Some doctors also follow additional guidelines that comprise the usage of specific diagnostic tools and supply beneficiaries. You can focus on these guidelines to maximize the return on oncology treatments through approved reimbursement claims.
1. Accurate Documentation
Most hospitals and clinics direct their doctors to maintain accurate documentation of their patient records. These records are vital for their medical oncology billing services as cancer treatments and procedures are complex and expensive.
Any irregularities or discrepancies in your documentation can result in payment delays and even claim denials for you. Therefore healthcare organizations must maintain accurate patient records and complete documentation to prepare and submit error-free reimbursement claims.
2. Classification of Medical Codes
There are different types of cancer; each type requires a different treatment with its diagnoses and procedures. As a result, the oncology department has a range of unique medical codes assigned to those services.
Therefore the medical sector has categorized its oncology codes into three categories to ease the billing process. Based on the oncology services available, you can differentiate the codes into these categories.
These categories are titled Current Procedure Terminology, International Classification of Disease and Healthcare Common Procedure Coding Systems.
3. Consistent Regulation Updates
Cancer research is currently on a worldwide rise therefore there are consistent updates in oncology treatments. The updates incline hospitals to adjust the medical codes assigned to their oncology services in the form of new regulations.
Current Procedure Terminology is the most common category used by doctors and undergoes the most updates. These updates are primarily made by the American Medical Association such that the code list is regularly updated.
In this way, hospitals can integrate new medical codes into their collection and also identify less valuable ones. Such codes are considered to be no longer useful for cancer treatments. Therefore you can record their activity and move on from them to focus on new codes.
4. Diagnostic Tools
There are several diagnostic tools available as well based on the set guidelines that can be utilized to manage medical oncology billing. International Classification of Diseases is a common diagnostic tool apart from a category of medical codes.
It has a global outreach with increasing usage to manage cancer-related injuries and deaths. This tool specifically categorizes the causes and symptoms of oncology cases and is constantly regulated in the form of updates.
5. Supply Beneficiaries
The guidelines of oncology medical billing have also provided a wide range of supply beneficiaries for doctors. These beneficiaries are in the form of collections of medical codes used to detail oncology procedures.
They also involve the medical supplies and overall cancer services utilized in the relevant healthcare treatments. In this case, you have to consider other stakeholders as well, especially insurance companies.
Oncology Medical Billing Drawbacks
Apart from its mostly positive role, oncology medical billing has some drawbacks as well that must be considered by healthcare organizations. They mostly comprise the complex nature of oncology treatments, regular technical changes and constant monitoring required.
1. Complex Oncology Treatments
Cancer patients have to constantly undergo a wide range of fluctuating symptoms. This makes their treatment more strenuous than other medical processes. In addition, they also complicate the treatments for oncology medical billers, doctors and patients.
As a result, you may have to constantly go back and forth with the consultation, preparation, treatment and follow-up procedures. Therefore you may find oncology treatment more complex than other medical services.
2. Regular Technical Changes
The rapidly changing nature of oncology medical billing requires healthcare organizations to make regular technical changes. These changes can be in various medical domains as the number of cancer patients is constantly rising.
This rise adds different body types to the scope of cancer that have different responses to tumor growth. Such growing differences make it difficult for doctors to keep up and adjust their technical compliance accordingly.
3. Constant Monitoring
The complexity and flexibility of oncology medical billing require the best doctors and medical billers. You must ensure that your staff constantly monitors their oncology practices by managing vital processes like patient negotiations and turnover.
Frauds can easily target oncology billing if it has not implemented a strict check and balance. Any malicious party can easily hide their frauds within its complex processes if it is not monitored properly.
An experienced team constantly monitoring the billing process can minimize the susceptibility of their healthcare organization.
The Bottom Line
This blog sheds light on the medical billing process implemented by hospitals for their cancer treatments. We mainly focused on the services involved and the guidelines set for this process along with some of its drawbacks.
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