The elements and difficulties of radiation-oncology billing

Radiation oncology is one of the most popular medical specialties in the US, with a wide range of healthcare professionals (from hospitals to independent practitioners) participating in the field. Cancer is one of the most prevalent diseases in the country. This indicates that radiation oncology makes a significant claim on the financial and human resources used in US healthcare. Unfortunately, because insurance procedures are so onerous, most of it remains unrealized.

The insurance process for radiation oncology includes patient registration, charge input, claim creation and transmission, payment posting, appeals for inaccurate claims and denials, collection management, and electronically submitting claims in accordance with HIPPA regulations.

Unfortunately, strict policy adherence, precise detail handling, and the capacity to transmit data electronically are not enough for the successful reimbursement of a radiation oncology episode; additional requirements include:

• Comprehensive knowledge of the extent of coverage to which you are entitled under your Medicare plan (there are three plans: A, B, and C).
• Determining if the cancer treatment was medically required and prescribed by a qualified medical professional.

It goes without saying that this results in unrealized payments (ARs) and ailing income for individual doctors, physician groups, clinics, diagnostic centers, long-term care facilities, and acute care facilities.

Outsourcing to PBC 

Radiation oncology billing and coding protocols are thoroughly understood by PBC’s billers and coders. We have a very comprehensive understanding of the diseases involved in radiation treatment versus the insurance procedures that apply to them thanks to our years of expertise with the complexities of radiation therapy billing and coding procedures.

Our methodical approach to rigorous follow-ups and correct data processing has allowed us to reduce the rate of claim denials for care providers in every state in the United States. The decline in claim denials is attributable to our quality consciousness. We put claims through multiple rounds of quality checks both during and after they are prepared to ensure that they are error-free when filed.

Because our service models are customisable, you can select the one that best suits your requirements and configuration. We provide two categories of models:

• RCM consulting Services
• Outsourcing

As part of our consulting strategy, your revenue management system will be thoroughly examined to help find areas where revenue is being lost, obsolete software, and training requirements. Our RCM solution will assist you in addressing these issues, ensuring a seamless revenue management procedure that can manage the intricacies of radiation therapy insurance requirements and minimise denied claims.

On the other hand, you can delegate all of your billing and coding duties to PBC if you don’t already have an internal staff for these tasks. Our outsourcing strategy covers all aspect of billing and coding, from determining the patient’s insurance eligibility to filing claims and following up after filing.

We offer services at every stage of preparing and submitting a claim:

Charge Entry : By validating patient demographics, medical codes, DOS, POS, provider details, units, modifiers, and more, as well as submitting claims to clearinghouses, our Charge Entry (CE) services guarantee error-free claim submission. Random quality checks are a component of audits in CE as well.

Payment Posting : The most sophisticated electronic remittance scenarios, such as denials, underpayments, overpayments, numerous adjustments, automated cross-over, secondary remittance, reversals, etc., are within the purview of our billers and coders.

Account Receivable : By following up with insurance officials, we lower your claim rejection rates and guarantee prompt payment for your services, enhancing your revenue.

With our team dispersed throughout all US states and billers and coders knowledgeable with state-specific exclusions, providerbillingandcoding.com is a nationwide network. This aids in our explanation of the inconsistent application of the laws throughout the United States. By enabling them to focus on their core services, PBC has assisted healthcare professionals across the US in increasing both the quality of their radiation oncology treatments and their revenue.