Oncology Billing 101: All you need to know
Cancer is a debilitating disease responsible for nearly 10 million deaths in 2020. For perspective, that is one in six deaths. The vicious nature of the disease overshadows the fact that it is treatable and curable, provided it is diagnosed in the early stages and the proper recourse adopted.
Oncology is the specialized medical branch that deal with all aspects of cancer – its prevention, diagnosis and treatment. It is a complex process, requiring significant time and resources to prevent and treat cancer. Consequently, the payment process or oncology billing requires detailed documentation of the treatment plans to ensure timely reimbursements.
Oncology calls for long, drawn out treatment procedures that are not just limited to radiation or chemotherapy. It starts with the numerous tests and checkups prior to the procedures, before moving on to pre-procedurals. After the treatment plan is completed, the post-procedural visits and checkups with physicians are also part of the oncological process.
Needless to say, the billing process can get quite complicated and messy if proper attention is not paid. It is not just hospitals that would be effected, but the patients would have to go through unnecessary drama to settle their bills. Effective tracking of procedures performed, their documentation, and payments made are all part of the oncology billing and coding process.
Another challenge lies in the different types of oncology procedures that are available today. Some of the most common ones are:
- Medical Oncology
- Surgical oncology
- Radiation Oncology
- Gynecologic Oncology
- Pediatric Oncology
- Hematologist Oncology
- Neuro Oncologist
Each of these require specific procedures for the treatment, which undoubtedly adds to the complexity. Additionally, there are frequent changes made to codes and compliance policies that can make oncology billing a nightmare for most. In a state where change is the only constant, oncology billing is no trivial matter.
Doctors and healthcare specialists do not have the time to focus on billing processes. It would compromise their attention towards the patient’s healthcare which would have disastrous results. Therefore, much of the oncology billing is left in the hands of the hospital administration.
Even so, administrative staff may not possess the required knowledge or proficiency to keep up with all the latest codes and compliance changes and track all procedures performed to draw up the bills. As a result, a hospital can fall in the red due to inadequate reimbursement for the treatment procedures it conducts.
Lately, doctors and hospitals are increasing relying on organizations that specialize in oncology billing to take care of their medical billing and revenue cycle management processes. This has benefited medical practices as they no longer have to grapple with issues related to correct use of prolonged service codes, insurance covering clinical trials, and can help maximize reimbursements and minimize claim denials. By ensuring accurate coding and billing, these organizations guarantee adequate compensation to medical professionals and establishments.
Oncology billing services have transformed the healthcare industry for the better. They are leveraging modern technology to ensure error-free and denial-free oncology billing and coding services. As advances in oncology take place and better treatment procedures, new technology, extensive surgeries, chemotherapy, mental health interventions, and long drawn out treatment plans become available, so does the complexities associated with oncology billing.
Nowadays, all sorts of procedures and treatment plans are accessible to the patient. This means that billing service providers have to always be on their toes. It pays to stay updated on what can be considered under Bundled procedures and what additional procedures actually entail. A small slip-up can lead to claim denials which is a huge revenue loss for the establishment.
While cancer is a deadly disease and its eradication should be a priority, one cannot deny the fact that the healthcare professionals who perform the task of caring for the patients deserve to be compensated. Medical practice may be a means to undertake a humanitarian mission but adequate compensation is a necessity.
Reimbursement for the treatment procedures pays for the resources and the wages of the medical personnel involved. Faulty or inadequate reimbursement can shut down a medical establishment and translates to one less facility for cancer treatment. This highlights the importance of accurate and denial-free oncology billing process in today’s healthcare industry and public health in general.