Healthcare is divided into many areas. Each medical domain has its processes. When it comes to medical billing, every department’s finances are managed using this process and thus is named after that healthcare area. For today, we will be talking about oncology medical billing and what are the processes involved.
Oncology refers to the medical treatments given for tumors and cancers, as a whole. This field has seen a hike in patients because cancer is increasing day by day. For the same reason, hospitals are making extensive use of medical billing procedures in order to manage their finances. This way they can pay more attention to the health of patients.
So here we will dive into the oncology medical billing and tell you all about this major billing sector.
Oncology Medical Billing Process
Instead of confusing you with oncology medical billing as a new term, let us tell you that the billing process is the same. The difference here is the name of the department. In any healthcare division, medical billing involves the same steps. Some steps might differ but here is a breakdown of precise oncology billing.
Patient Registration
First of all, patient’s information is collected when they visit the hospital. Here some expected charges are also communicated to the patients, which may vary depending on the severity of the case.
Document And Coding
Once the treatment is started, medical billers list all the procedures and supplies throughout the treatment in the bill. These procedures are then translated into codes to create claim applications.
Claim Submission
After the creation of the bill, as we discussed, the codes are identified, on the basis of which claims are made. This is then sent to the insurance payers of the patients. This is the crucial step in the entire oncology medical billing because here it is decided whether the insurance payer will make the reimbursement or not.
Denial Management
If the bill is accepted, healthcare facilities become relieved. But if any claim faces a rejection, they have to put in additional efforts to resolve the payer objective. Then it is sent again to them to get the payment. This is an adverse step because claims once rejected and resent have less chance of approval. So claim denials in other words mean loss of revenue.
Patient Billing
When the insurance payer has made the payment, the last step is to send the bill to the patient and receive the payment. This is a crucial step because not all patients respond quickly to the bill. So there must be a constant follow-up maintained in order to mark the oncology medical billing complete.
Common Codes In Oncology Billing
In the billing process, only 2 things are emphasized, the process and the codes. Billing codes are a crucial element to know because this is the base upon which your revenue depends. Since patients having insurance coverage owe relatively less amount in terms of deductibles and copayments as compared to the coverage itself. So receiving a large portion of your bill from payers is important and is done through medical codes.
The claim application we discussed contains some codes. Insurance payers then read those codes, check the accuracy, and approve or reject the application. These codes vary according to the healthcare departments. For oncology medical billing, there are too many unique codes that are not used in any other medical processes than oncology. Let’s have a look at them:
CPT (Current Procedural Terminology) Codes
96413-96549: Chemotherapy administration codes for intravenous, intramuscular, and subcutaneous injections.
77263-77799: Radiation therapy codes, including simulation, treatment delivery, and guidance procedures.
36415: Routine blood drawing, often used for laboratory tests related to oncology.
ICD-10 (International Classification of Diseases, 10th Edition) Codes
C00-D49: Malignant neoplasms codes, specifying the type and location of the cancer.
Z51.0-Z51.89: Encounter for other and unspecified procedures and aftercare, including chemotherapy and radiation therapy follow-ups.
HCPCS (Healthcare Common Procedure Coding System) Codes
J9000-J9999: Chemotherapy drugs, including both injectable and oral medications.
G6001-G6015: Radiation therapy delivery codes for various modalities.
Evaluation And Management (E/M) Codes
99201-99499: Codes for office visits, consultations, and hospital visits based on the complexity and level of service.
Molecular Pathology Codes
81162-81479: Codes for molecular and genetic testing to identify specific genetic markers and mutations.
Surgery Codes
10000-69999: Codes for surgical procedures related to oncology, including excision of tumors and biopsies.
Imaging And Diagnostic Codes
70010-79999: Radiology codes for imaging studies, such as CT scans, MRIs, and PET scans.
Laboratory And Pathology Codes
80047-89398: Codes for laboratory tests and pathology services, including tumor marker tests.
Infusion And Injection Codes
96360-96379: Codes for hydration, therapeutic, prophylactic, and diagnostic injections and infusions.
Pain Management Codes
G89.3: Neoplasm-related pain.
G89.4: Chronic pain syndrome related to cancer.
Common Challenges In Oncology Billing
Oncology is a field that comes with its challenges besides having a lot of benefits. Since no error should happen during the billing process because your finances and the patent’s financial condition are based on that, keeping some information about the obstacles is essential. Here we have listed common hurdles faced during the oncology medical billing process.
Complex Coding
Oncology treatments are prolonged. That’s why keeping accurate and complete procedures coding and documentation is essential. You must keep an eye on all patient visits and therapies happening. Their treatment may run for extended periods. So ensure careful record keeping for each individual.
Healthcare Regulations
Medical billing involves a constant change in rules and regulations. It is crucial to stay updated with all trends. Utilize current approaches to billing and coding. Also, use updated codes for oncology billing. Read all new and deleted codes to avoid inaccuracy in your bills and claims.
Lengthy Reimbursement
Oncology claim applications due to extended bills may face an extended approval period. Insurance payers may take more time to review the claims. So here knowing some practices to simplify the process and instant claim approval should be utilized.
Remember that if payers take long to make the reimbursement, and if unfortunately the claim is rejected, the process might go a lot longer after the resubmitting of the claim. In that case you will lose the chances of getting complete revenue. So you must be aware of 100% claim acceptance techniques.
Specialty Medications
Costly specialty medications are often used in oncology treatments. Payer policy knowledge and attention to detail are necessary when handling the billing and reimbursement for these medications, which may be provided in a variety of settings.
Clarify Patient Responsibilities
Last but not least, oncology treatments are quite expensive. You must ensure that patients are aware of their financial responsibilities like expected bills, co-payments, and deductibles. This way they will ask for financial assistance early on to avoid future inconvenience, making the process smoother and hassle-free.
Oncology Billing Success
Despite the simplicity of oncology medical billing, there are some things you need to know. So here we have collected a detailed guide on things you should consider if related to the oncology department.
This guide will enable you to perform oncology billing by keeping these considerations in mind. It will ensure the correct implementation of the process, guaranteeing your financial success and patient’s health improvement.