Precision in billing and coding is required to give patients care and consideration since oncology doctors manage one of the most serious patient diagnoses. Oncology medications are costly, and healthcare practitioners cannot afford to lose money if billing and coding are done incorrectly. Besides, healthcare providers’ revenue cycle management methods will be significantly impacted by improper and erroneous cancer coding procedures.
The chosen foundation for specialized cancer practices is oncology coding. However, if the coding is done incorrectly, you will stop receiving revenue payments. Therefore, you must be prepared for it! Therefore, while specific codes are necessary for oncology coding, appropriate medical oncology coding procedures are necessary for revenue payments. And here are some other crucial aspects regarding the same:
How Can Oncology Coding Be Useful?
Oncology patients typically struggle with their physical and financial well-being. And this combination forces doctors to spend more time with each patient while also running the risk of payment issues brought on by under or over-coding.
The medical oncology billing partner you outsource must understand the distinction between a consultation and a new patient visit to handle billing and revenue cycle management procedures like a compliance audit. It also guarantees the correct use of codes for extended services, clinical trial insurance, and particular operations like transplants. And as a result, it might increase payouts and decrease claim denials.
What Are the Major Types of Oncology Codes?
Three categories of codes are utilized in cancer medical billing and coding, and they are the Healthcare Common Procedure Coding System, the Current Procedural Terminology, and the International Classification of Diseases, Tenth Revision, and Clinical Modification. So, as healthcare providers, oncology professionals must abide by HIPAA’s laws and regulations. Failure to do so may result in hefty fines annually for each type of infraction. Besides, there is also a chance of receiving a prison sentence for a crime.
An oncology coder makes sure that all diagnoses and treatments—including radiation, chemotherapy, transfusions, infusions, and injections—performed by a doctor or nurse are correctly documented. They examine the paperwork and diagnostic test findings to gather and evaluate patient data. The input of conditions and procedures should be accurate and per ICD-10-CM, CPT, and HCPCS while avoiding some of the usual problems and errors.
By following the regulations and standards established by the government and healthcare providers, an oncology coding specialist should precisely identify and validate data for each patient contact. Another aspect of their duty is to cooperate with other members of the medical billing team and other colleagues engaged in the billing procedure. Medical coders also examine claim denials and offer suggestions to rectify the problems per the insurer’s rules.
In contrast to other medical specialties, medical oncology coding has varied coding standards. Therefore, finding the appropriate codes to use presents unique difficulties for coders. In any case, they must utilize the proper codes for insurance providers to approve the claims and reimburse oncology practitioners. On the other hand, an insurance company won’t approve a claim if the codes are off. And as a result, claims may be disputed repeatedly until and unless the biller and the payer agree. For instance, there are many allocated codes for giving a patient chemotherapy, and each code denotes a distinct level of seriousness. So, the oncology coder may use the wrong code if they cannot precisely determine its severity.