6 Challenges of Radiation Oncology Billing (+ Solutions to Overcome Them)

March 16, 2021 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Radiation Oncology

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Accurate billing and coding practices are necessary for any healthcare provider - regardless of specialty - to receive reimbursements from insurance companies. However, radiation oncologists may feel increased pressure for a high clean claim rate. Besides having to adhere to the unique billing and coding guidelines for radiation oncology practices, the generally higher reimbursement rates of this specialty may make practitioners feel as if they need to be extra particular. 

While radiation oncologists have challenges unique to their specialty, following these solutions can help overcome the most common radiation oncology billing obstacles  - and help lead to improved revenue cycle management!

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How Efficient Medical Billing Processes Can Benefit Radiation Oncology Practices

For healthcare providers to receive payments for their treatments of insured patients, they must bill the insurance providers through the use of complex billing and coding guidelines. Medical billing is the process by which a healthcare provider is paid for their services by billing both patients and insurance companies so the provider can receive their due compensation. Since the timeliness of medical billing depends on how accurate and complete the medical billing claims are, ensuring the most accurate claims are being filled has a direct correlation to your revenue. 

When claims are missing information or contain mistakes, then the insurance company will reject them - resulting in delayed or denied payments. For radiation oncology practices with typically higher reimbursements per procedure due to the specialty, any denials or delays can directly affect your practice’s bottom line. Denied claims take money and time to be reviewed, edited, and submitted. By the time the originally contested claim is re-submitted and approved by the insurance company, it could be weeks - if not longer - for your radiation oncology practice to finally receive your reimbursements. Reworking rejected claims can take up to twice the amount of time to process and resolve errors, which takes time away from focusing on other areas of your practice and delivering care to your patients.

By streamlining your radiation oncology billing processes, your practice can ensure efficient and accurate reimbursements as much as possible so you can get paid quickly and not need to spend valuable time reworking claim mistakes. One way to enhance the billing process is to be aware of the most common radiation oncology billing obstacles so you can prevent them from posing a problem. 

Common Radiation Oncology Billing Challenges

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By avoiding these frequent radiation oncology issues, your practice can remove the obstacles to an efficient billing process. 

Medicare 2021 Adjustments 

In 2021, the Centers for Medicare and Medicaid Services (CMS) is planning significant cuts in reimbursement value for radiation oncology and other specialties. This may present significant financial challenges for radiation oncology practices as the year progresses. While these changes to are now looking to be enacted in July 2021 after strong industry pushback, the expected impact on radiation oncology is a combined reduction of 6% on payment rates for 2021. With these changes in mind, it’s important for radiation oncology practices more than ever to have streamlined billing processes for the most steady flow of incoming revenue. 

Incomplete Claims

One of the most common medical billing challenges across all specialties is submitting inaccurate claims. This could look like an incomplete claim that is missing information. For instance, a single empty or unchecked box or a missing line of patient information can result in a claim denial that can take weeks to fix. This includes fundamental information such as the patient’s full name, gender, date of birth, and time of the accident or medical emergency. 

Inaccurate Claims

Just as with incomplete claims, claims with miscoding or typing errors can also land your radiation oncology practice with unwanted denials. Whether it’s a duplicate charge, an unbundled code, an incorrect date, or entering a code with too many or too few digits, then your claim will be delayed or denied. Common miscoding mistakes may include:

  • Submitting incorrect radiation oncology CPT codes.
  • Entering ICD-10-CM codes with too many or too few digits. 
  • Leaving out specific oncology CPT codes.
  • Submitting inaccurate patient, insurance, or provider information. 

Undercoding or Upcoding

A form of inaccurate billing, undercoding or upcoding in radiation oncology billing are both illegal procedures that can result in fines or criminal prosecution. While this can be done deliberately, undercoding or upcoding claims can be accidental. While upcoding occurs when codes are entered into a patient’s bill for services that were not received, undercoding occurs when codes 

are left out of a patient’s bill. While these inaccuracies can result in denials, they also can get your radiation oncology practice red-flagged for an audit - and potential fines. 

Disorganized Patient Records

Lack of documentation or disorganized records can result in mistakes in your patient records which can lead to denied claims. If claims are denied and need to be contested, then organized patient records will be crucial during the review process. If your radiation oncology practice is audited, then well-documented patient records will be required. 

Ineligible Insurance Coverage

Oftentimes, issues with insurance companies over claims are the result of patients having ineligible insurance coverage. This is usually the result of unchecked coverage of established patients; if there have been changes to your regular patient’s insurance coverage and your patient records have not been updated, then it’s likely the insurance company will deny the claim. 

Solutions to Overcome Common Medical Billing Challenges in Your Radiation Oncology Practice

So, how can your radiation oncology practice overcome these obstacles to bring about improved revenue cycle management

Verify All Insurance Coverage

To avoid problems with insurance companies over patient insurance coverage, make sure to consistently update your patient records. Implementing a step in your billing workflow that verifies the patient’s insurance at every visit can prevent any denials due to insurance coverage ineligibility. By doing so, you can catch potential disruptions, such as terminated coverage, services not authorized, services not covered by the plan, or maximum benefits reached.

By outsourcing verification and other elements of the revenue cycle to a trusted third-party medical billing service, your practice can eliminate potential eligibility issues.

Keep Accurate Patient Records

To help ensure all your patient charts and records are as accurate and organized as possible, your radiation oncology practice should conduct regular medical billing audits. An audit combs through all your present patient data and records to identify, monitor, and correct any inaccurate, incomplete, or inappropriate billing practices, as well as review that all information is up to date. 

Submit Accurate & Complete Claims

While most of the issues relating to claim denials may be due to incorrect or missing information on claims, by taking the time to ensure everything is complete and accurate, your radiation oncology practice can increase your clean claims rate. For instance, ensure there’s a second set of eyes reviewing each paper or electronic claim to your office files to make sure the required fields are completed. Or, if you’re only using electronic claims, check that your software system flags users to review missing fields and input all required info before allowing them to submit to ensure the most accurate claim submittals. Not only will these extra steps ensure accurate billing, but they will also help to prevent undercoding or upcoding. 

Additionally, outsourcing your medical billing process to a trusted third party allows for the responsibility of accurate medical billing to be in the hands of professional staff trained in the complex billing and coding guidelines for radiation oncology practices. This allows your own practice to focus on other areas of improvement while not stressing over the medical billing process. 

Improve Medical Billing Processes for Your Radiation Oncology Practice with NCG

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An efficient radiation oncology billing process is one of the key components of successful practice in the specialty. While it may be a challenge in itself to balance building a business and delivering care to patients while avoiding the above-mentioned obstacles, following the best practices as solutions to these issues can bring your practice the revenue cycle management you need. 

By leaving your medical billing needs to NCG Medical, you can worry less about your medical insurance billing and spend more time and energy on your patients. With experience in both hospital and private practice radiation oncology, our team can effectively empower your healthcare practice and boost your bottom line. To learn more about how NCG Medical can transform your radiation oncology billing for a more financially stable future, contact us today.

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