Operative Ways to Overcome Medical Billing Challenges Of Oncology Practices

Are you facing more pressure to expand your business on razor-thin margins? If so then you must look for some fundamentals to deliver better financial results to your patients while cutting costs & reducing errors. However, it may look alike a tedious chore. Regardless of specialty, accurate medical billing and coding is a necessary step to maintain the financial wellbeing of a medical facility. You can’t deny the fact, that medical billing and coding play a huge role to make your business financially strong. But, sometimes, it becomes so tough for healthcare providers to adhere to the latest medical billing and coding regulations. Besides, it is quite an impossible task to receive full reimbursements from the payers. That’s the reason numerous oncologists are suffering due to aggravated stress for a high error-free claim rate.

Thereby, they face maximum errors in claims and claim rejections due to these issues. Which further impacts the revenue cycle management of an oncology practice drastically. Many medical professionals face unique requirements and challenges associated with medical oncology.

Significance of Efficient Medical Billing Processes

To get reimbursements for the rendered services, providers have to contact the insurance carriers and bill the claim by the use of complicated billing and coding rules. You can say medical billing is a procedure of billing both payers and patients for the services given to the patients- so healthcare practitioners can get reimbursed on time. It has a direct correlation to your revenue. Once you assure your medical claims are accurate and complete, the timeline of medical claims gets short and you receive the compensation of the services promptly. On the other hand, when there are mistakes and missing information in the claims. It will lead to denials and rejected payments.

However, denials affect the bottom line when oncology practices due to complex specialty face billing issues. Rejected claims take a lot of time and resources to edit, rework, resubmit, review, etc. Moreover, often reworking claims inhibit you from delivering care to your patients and focusing on other areas of your practice as it takes up twice an amount of time to resolve errors and process.

You don’t need to rework claim denials when you have an efficient process in place. Effective physician billing services enable you to witness accurate and efficient reimbursements. Moreover, staying aware of the following challenges will enable you to stay competitive in the market and remove the obstacles to an efficient billing process.

Plus, we have compiled here a complete roadmap to avoid healthcare malpractices, check this out or reach to our online agent to have a quick understanding.

Incomplete Claims

Submission of an inaccurate claim is one of the most common billing challenges across all specialty-specific practices. This signifies missing data and incomplete claims. For example, a minor mistake in the information of patients and missing line or box results in claim rejections which take months-weeks to resolve. It includes the general data such as the name of the patient, birthday, gender, address, medical emergency or accident time, etc.

2021 Medicare Adjustments

As 2021 is progressing the oncology practices are shutting down due to unprecedented financial challenges such as Medicare adjustments. CMS was planned for oncology and other specialties to make certain cuts in reimbursement value. These changes are already enacted in 2021 July. Due to these amendments, it has now become more important for oncology practices to have a steady flow of incoming revenue and streamlined billing processes.

Inaccurate Claims

Just as with missed claims, claims having typing mistakes and miscoding errors may land your healthcare business with undesired rejections. Your claim will be rejected whether there is a duplicate charge, an incorrect date, unbundled code, coding with few digits, etc.

Some common errors in miscoding involve;

  • Leaving out particular oncology CPT codes./li>
  • Submitting inaccurate oncology CPT codes.
  • ICD-10-CM codes entering with a few or many digits.
  • Submitting inaccurate patient, provider, or insurance data.
  • Not entering codes at all in a present claim.

Lack Of Patient Documentation

It will lead to rejections when the mistakes in your patient records are due to disorganized records and lack of documentation. That’s the reason, the organized records are significant during the procedure of review- if the medical claims are denied or they need to be contested. At this point, well-documented records of patients will be needed if your oncology practice is audited.

Upcoding & Under-Coding

In oncology billing, under-coding and upcoding (forms of inaccurate coding) are considered illegal which can lead to criminal prosecution or oftentimes fines. Under-coding occurs when codes are left out from the bill of a patient while upcoding occurs when codes are registered in the bill of patients for those administrations which are not received. These can be accidental while that can be done deliberately too. Eventually, your medical business can face potential fines and get the red flag for an audit due to these inaccuracies resulting in denials.

Ways to Overcome Common Medical Billing Challenges

Precise Patient Records

Healthcare providers must conduct a regular audit to ensure all their patients’ records and charts are organized as well as accurate. Medical billing audits identify, review, monitor, and rectify any incomplete, inaccurate, missed, inappropriate billing practices by combing through all your present patient data & records. It helps you review that all the provided data is updated.

Insurance Coverage Verification

Make sure you have all patients records updated to avoid any problems with the patient insurance coverage and insurance companies. You can prevent the claim rejections caused due to insurance coverage eligibility when you implement a step in your billing workflow that during each patient’s visit verify the patient’s insurance. This also enables you to grab any possible disruption such as services not authorized, maximum benefits reached, terminated coverage, and services not covered by the plan, etc. Taking professional support from an RCM expert can enable you to eliminate patient eligibility problems and verify all insurance coverage efficiently.

Complete & Accurate Claims

Most problems in the claims are due to missing or incorrect information. When you rectify those issues by making sure that everything is accurate and complete resulting 100% clean claim rate. You should ensure the required fields are completed and if you use an electronic system just make sure your system input all required data and flags users to review missing fields. By doing so, you can prevent upcoding and under-coding errors and assure the most accurate claim submittal. Experienced medical billing teams have required skilled or trained personnel who understand and stay up-to-date with the coding & billing guidelines for oncology. This will allow you to not stress out over the medical billing procedures and focus on other key areas of improvement.

Improve Oncology Billing Practices

The key component of a successful specialty-specific practice is having an efficient billing process. At that point, it is also quite difficult to deliver care to patients by building a business while avoiding the above-mentioned obstacles. These best practices act as a solution to these concerns & can bring your practice the revenue cycle management you need. You can worry less about your medical insurance billing when you leave your medical billing needs to an experienced billing firm, such as Physician Billing Company. PBC billing experts will transform your oncology billing for a more financially stable future and help you to boost your bottom line & empower your healthcare practice!


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