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Hematology/Oncology is often riddled with complications when billing out charges for various encounter types.
The ongoing changes in the healthcare environment have necessitated that a billing team have dedicated and prompt follow through on denials and no claim responses. The range of patient care issues provided by Hematology/Oncology practitioners is wide and varied. Even though our focus is on medical billing and accounts receivable management, our broad experience across the entire Revenue Cycle Management process in a Hematology/Oncology practice is why we can give you an advantage compared to in-house billing.
We understand that hematology/oncology is a unique and sensitive specialty and our staff treats it as such. We also are experts at the complicated coding and billing aspects of the specialty and our front-end system is designed to collect and bill the codes per specific payer guidelines developed over many years of experience.
What we know…
Did you know there is a hierarchy in billing infusion services? CPT guidelines follow a strict hierarchy of coding regarding injections and infusions. Chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services, which in turn are primary to hydration services. Infusions are primary to pushes, which in turn are primary to injections. A good question to ask is “What is the reason for today’s visit?”. This will start you on the right path to submitting a clean claim.
Advanced Care Planning: Two new CPT codes have been added as of January 1, 2016 for Advanced Care Planning they are 99497 and 99498. Per CMS, “According to the Final Rule, you can report 99497 and 99498 on the same date as other E/M services, transitional care management and chronic care management. This is also billable during global surgical periods. You cannot, however, report 99497 and +99498 on the same date as certain critical care services, including neonatal and pediatric critical care.”. This is a time based service and your documentation must support that no other management of any problem was done during this time frame.
ICD-10 2017: Expect revision to the codes for Hodgkin Lymphoma. These revision will align the codes to the widely accepted classifications of Hodgkin Lymphoma.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Hematology/Oncology practices. Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. Having an experienced medical billing team, with visibility into performance, is vital to your practice’s financial health.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package