Oncology Practice Billing
Oncology is one of the most complex medical specialties, requiring a highly specialized approach to medical billing and insurance claims. Oncology practices deal with extensive insurance coverage details, unique billing challenges, and ever-changing regulations. Unlike other specialties, oncology medical billing involves chemotherapy drugs, radiation therapy, and advanced imaging tests, making it essential for medical billing teams to have extensive expertise.
Oncology billing is one of the most intricate medical billing specialties due to chemotherapy, radiation therapy, complex imaging tests, and strict insurance guidelines. Handling it in-house often leads to errors, increased claim denials, and revenue loss. A good medical billing company like us can help you by providing expertise in oncology coding, faster claims processing, cost-efficiency, and compliance and risk management. If you wish to optimize your billing process, outsourcing to a specialized medical billing company like us can ensure smooth operations and maximum reimbursements.
Unbeatable Service, Quality & Price
ACCURACY
0
%
TURNAROUND TIME
<
0
Hours
COLLECTION
0
%
PRICE
Starting from $
1100
/Month
CHALLENGES
Challenges in Oncology Practice Billing
Complexity of Chemotherapy Drug Billing: Oncology drugs are some of the most expensive medications in healthcare with infusion therapies often costing thousands per session. Billing these drugs requires:
- Using correct HCPCS Level II codes for drug administration.
- Ensuring accurate units of dosage are reported.
- Applying the right modifiers for multi-dose administrations.
- Verifying National Drug Code (NDC) requirements for drug claims.
Frequent Insurance Denials: Oncology billing faces some of the highest denial rates due to:
- Lack of pre-authorization for imaging tests or chemotherapy.
- Incorrect ICD-10 coding or missing diagnosis linkage.
- Insurance carriers reject high-cost treatments unless step therapy protocols are followed.
Compliance with Government Regulations: Oncology billing must comply with:
- Medicare LCDs (Local Coverage Determinations) for drug coverage.
- OIG (Office of Inspector General) regulations to prevent fraud.
- HIPAA guidelines to maintain patient privacy.
Failing to adhere to compliance rules can lead to audits, fines, and legal issues.
OUR PROCESS
Our Oncology Practice Billing Process Workflow
At RCM Workshop, oncology practice billing process starts with patient registration, where we collect and verify patient information and insurance details. After that, we obtain necessary pre-authorizations from insurance companies for treatments such as chemotherapy and radiation therapy and document patient medical history, diagnosis, and treatment plans in detail. Then we assign appropriate diagnostic (ICD) and procedural (CPT) codes specific to oncology services. These codes are used to submit claims to the patient’s insurance company, which reviews the claim, determines coverage, and processes the payment. Subsequently, payments from the insurance company are posted to the patient’s account.
If any claims get denied, we correct errors and resubmit the claims. After insurance payments are posted, we bill any remaining balance, not covered by the insurer, to the patient. The last step involves collections, where we follow up on unpaid patient balances, and manage collections as needed. This workflow ensures accurate and timely reimbursement for oncology services while maintaining compliance with regulations.
Scheduling & Registration
Carry out well-coordinated appointment scheduling, update insurance details, and handle inbound and outbound calls from/to patients.
Eligibility & Benefits Verification
Confirm primary and secondary insurance and benefits coverage of patients and verify their coverage, co-pays, co-insurance, and deductibles.
Prior Authorization
Initiate request for prior authorization with the payer, follow up to check its status till closure and finally update the system with Auth approval reference number.
Medical Coding
Check the accuracy of codes and modifiers according to specialty and assign corresponding and appropriate charges to the codes.
Charge Posting
Enter the charges for the services provided into the billing system including the cost of the medication and the administration fee.
Claims Edits & Submission
Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.
Payment Posting
Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.
Denial Management
Analyze and categorize denial claim according to denial codes, $ amount and payers, and resubmit claims after correction.
AR Management
Follow-up with payers to gather status for unpaid claims, and their resolution.
Patient Collection
Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.
BENEFITS
Outcomes Guaranteed
Our organized approach to managing oncology practice billing offers actionable insights to enhance your ROI. We ensure compliance with the latest regulations and standards, making your center audit-ready and protected from legal issues. Our team upholds the highest quality standards, guaranteeing significantly improved financial outcomes.
WHY US?
Why partner with us
By partnering with us, you can simplify your oncology practice’s intricate billing process, ensuring precision and regulatory compliance. This collaboration can reduce the risk of errors and denials, resulting in faster reimbursements and improved financial stability. By delegating billing tasks, your center can concentrate more on patient care and clinical operations, boosting overall efficiency and patient satisfaction. Besides, we can provide you with valuable insights and analytics to optimize your revenue cycles and efficiently manage patient billing and collections.