Outsource Oncology Billing Services to optimize Revenue through our Oncology Revenue Cycle Management in the U.S.

Use appropriate E/M (Evaluation and Management) codes with modifiers to reflect the increased complexity of oncology consultations, treatment planning, and coordination. Document the time spent on these activities meticulously. Consider using add-on codes for prolonged services if necessary.

For new treatments without specific codes, bill using appropriate unlisted service codes with detailed documentation justifying the service and its medical necessity. Stay updated on HCPCS (Healthcare Common Procedure Coding System) updates for potential new code assignments.

Understand the bundled payment model for your specific oncology care. It may require bundling multiple services into a single payment. Collaborate with your billing team to ensure accurate coding and capture all services provided within the bundle.

Bill oral chemotherapy drugs using specific J-codes and modifiers. Identify and bill separately for supportive medications using appropriate HCPCS codes.

Use specific codes for genetic testing procedures and counseling services. Ensure proper documentation linking the test to the patient’s cancer risk assessment.

Use the designated POS code based on the location where the service is delivered. For example, use code 11 (Office) for outpatient clinic visits and code 22 (Inpatient Hospital) for services rendered during hospitalization.

Familiarize yourself with relevant oncology-specific modifiers like 25 (Significant additional overdue service) or 59 (Distinct procedural service). Use appropriate modifiers to accurately reflect the variations in procedures performed during your oncology practice.

Work with your billing team to understand prior authorization requirements for specific oncology services. Appeal denied claims with clear and detailed documentation supporting medical necessity.

Maintain thorough and detailed documentation for all oncology services. This includes the complexity of the case, time spent, treatment plan, and justification for all services rendered.

Stay updated on oncology billing regulations and coding updates. Implement a strong internal compliance program to minimize errors and prepare for potential audits. Consider partnering with a qualified oncology billing specialist for additional guidance.