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Oncology

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Oncology

Navigating the complexities of oncology billing requires expertise, precision, and a deep understanding of payer guidelines. We provide specialized oncology billing services to ensure accurate claim submissions, compliance, and maximum reimbursements for your oncology practice. Let us help you streamline your revenue cycle while you focus on delivering exceptional cancer care to your patients.

Oncology is the branch of medicine dedicated to the prevention, diagnosis, and treatment of cancer. This field involves a multidisciplinary approach, including medical oncology (chemotherapy and immunotherapy), radiation oncology (radiation therapy), and surgical oncology (tumor removal). Oncology treatments often involve high-cost therapies and intricate care plans, making accurate and efficient medical billing essential.

Types of Oncology Treatments and Procedures
  • Chemotherapy
    • Administration of intravenous or oral anti-cancer drugs
    • Management of side effects and toxicities
  • Radiation Therapy
    • External beam radiation therapy (EBRT)
    • Brachytherapy (internal radiation)
  • Immunotherapy
    • Use of checkpoint inhibitors, CAR-T cell therapy, and monoclonal antibodies
  • Targeted Therapy
    • Precision drugs designed to target specific cancer cells without harming normal tissues
  • Surgical Oncology
    • Tumor resections and biopsies
    • Debulking surgeries
  • Palliative Care
    • Pain management and symptom control for advanced-stage cancer patients
  • Diagnostic Procedures
    • PET scans, MRIs, CT scans, and biopsies
Common Diagnosis Codes, Procedure Codes, HCPCS Codes, and Modifiers in Oncology Billing
Diagnosis Codes (ICD-10):
    • C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung
    • C50.911: Malignant neoplasm of unspecified site of right female breast
    • C61: Malignant neoplasm of prostate
    • D49.0: Neoplasm of unspecified behavior of digestive system
    • Z85.3: Personal history of malignant neoplasm of breast
Procedure Codes (CPT):
    • 96413: Chemotherapy administration, intravenous infusion technique; up to 1 hour
    • 77295: 3D radiotherapy plan, including dose-volume histogram
    • 77014: Computed tomography guidance for placement of radiation fields
    • 38900: Intraoperative identification of sentinel lymph node(s)
    • 76000: Fluoroscopy (separate procedure) up to 1 hour
HCPCS Codes:
    • J9190: Injection, fluorouracil, 500 mg
    • J9035: Injection, bevacizumab, 10 mg
    • J9312: Injection, rituximab, 10 mg
    • Q5108: Injection, trastuzumab, biosimilar, 10 mg
    • A4657: Syringe, with or without needle, sterile
Common Modifiers:
    • 25: Significant, separately identifiable evaluation and management service
    • 59: Distinct procedural service
    • 76: Repeat procedure or service by the same physician
    • RT: Right side
    • LT: Left side
Challenges in Oncology Billing

Oncology billing presents unique challenges due to the complex nature of cancer treatments, frequent changes in payer policies, and the high costs associated with care. Here are some common issues:

          1. Prior Authorization Requirements: Oncology treatments often require prior authorization for chemotherapy, radiation therapy, and advanced imaging procedures. Delays in obtaining approvals can disrupt treatment timelines.
          2. Complex Drug Administration Coding: Billing for chemotherapy and immunotherapy involves precise documentation of drug dosages, infusion times, and administration routes.
          3. High-Cost Treatments: Oncology therapies such as CAR-T cell therapy and targeted drugs require meticulous documentation to justify medical necessity.
          4. Frequent Policy Updates: Payer-specific guidelines for coverage and reimbursement often change, requiring continuous education and adaptation.
          5. Medical Necessity Denials: Claims are frequently denied if treatments are not deemed medically necessary. Robust clinical documentation is essential.
Common Denials in Oncology Billing
          1. Authorization Denials: Treatments or procedures performed without prior authorization are often denied.
          2. Incorrect Coding: Errors in coding infusion times, drug quantities, or procedures can lead to rejections.
          3. Bundling Issues: Some services are bundled, and unbundling them without proper justification can result in denials.
          4. Eligibility Verification Errors: Claims are denied if the patient’s insurance coverage is not verified or active.
          5. Incomplete Documentation: Missing clinical notes, pathology reports, or treatment plans can lead to claim rejections.
Why Choose Internal Oncology Billing?
          1. Specialized Expertise in Oncology Billing Our team has extensive experience managing the complexities of oncology billing, ensuring accurate coding and timely reimbursements.
          2. Dedicated Prior Authorization Team We handle all prior authorization requirements to prevent delays in treatment and claim submissions.
          3. Customized Solutions We offer tailored billing strategies to meet the unique needs of oncology practices, whether you focus on medical, surgical, or radiation oncology.
          4. Proactive Denial Management Our experts identify and resolve denial trends to minimize revenue loss.
          5. Transparent Reporting We provide detailed financial reports and analytics, giving you full visibility into your revenue cycle.
          6. Leverage Technology Using advanced technologies such as Artificial Intelligence (AI) and Robotic Process Automation (RPA), we automate eligibility checks, claims tracking, and coding processes. This reduces errors, improves efficiency, and ensures faster reimbursements.
The Importance of Specialized Oncology Billing

Given the complexities and high costs of oncology treatments, accurate and efficient billing is crucial for maintaining financial health. Partnering with a specialized oncology billing provider ensures compliance, reduces administrative burdens, and improves cash flow.

Key Benefits of Professional Oncology Billing:
  • Accurate Coding and Compliance: We stay updated with the latest coding guidelines to ensure accuracy and compliance.
  • Faster Reimbursements: Streamlined processes and proactive denial management reduce delays in payments.
  • Cost Efficiency: By outsourcing billing tasks, your practice saves time and resources while improving profitability.
  • Enhanced Patient Experience: Minimizing billing errors and delays allows your practice to focus on delivering quality care.
  • Comprehensive Support: From pre-authorization to denial resolution, we handle every aspect of your billing process.
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