As an Oncology practice, you face many complex billing issues, whether it is how to bill properly for multiple infusions, hydrations and therapeutic injections, or understanding payer rules for reporting drug wastage.
At Strategic Solutions, we review details such as correct units, time reported for proper coding of administration CPT codes, new coding edits or even areas of focus from the Office of Inspector General.
Oncology is one of the more complex billing areas that include several challenges:
- The proper use of treatment administration codes. We understand that there can be multiple administration codes on one claim and how to apply these per chemo drugs vs. therapeutic drug, as well as proper route and times.
- Thorough denial review process. At times an insurance company's internal edits result in inappropriate denials. All denials are reviewed by our certified coders and appealed when needed. Nothing is adjusted off unless the denial is valid, assuring you get paid the money you deserve.
- Variations among payers on how and when to use modifiers. We know what each major insurance company expects and work with your to get the right information to the payers. This includes the proper use of the JW modifier for reporting drug wastage and the documentation required to support this, as well as the proper use of modifiers.
- Assurance that the complex care you provide your patients is reflected in the coding of services and ultimately in your reimbursement. Our coders are well versed in diagnosis coding for Oncology/Hematology with experience using the Neoplasm Table, proper sequencing of diagnosis codes and determining the correct codes for unspecified vs. uncertain behavior.
Strategic Solutions helps Oncology/Hematology practices face today's challenges and achieve financial success in a complex healthcare marketplace. For more information contact us at 518-348-1276.