Chemotherapy Coding Audit: We pay cash for drugs!


The concept of a chemotherapy coding audit is very simple and profitable for you.  Follow this business scenario:

While an Oncologist specializes in cancer treatment, they are using their medical knowledge and expertise to attract resources to come through the office (i.e. patients who have insurance/ability to pay).  We all kno that just because the money is on the table, doesn’t mean it will make it into your pocket.  Ask yourself, “Of the amount that insurance will pay, how much do you actually collect?” Rhetorically, the answer is always, “Not enough.”
chemotherapy coding aduit chalkboard-resized-600-small_So what happens to the money that is not collected?  There are various answers, but the important one for the doctor is, “It doesn’t end up in your bank account.”  Every doctor, office manager, and medical biller knows that managing the efficiency of this process (depending on the specialty) is very complex.

To break down the process, let’s look at the 8 steps to the left.

Is it a surprise that most of the errors occur in steps 2, 3, or 4?

The good news with chemotherapy is that this data should be systematic and show definite patterns when analyzed on a broad spectrum.  Performing a chemotherapy coding audit on your practice data will reveal what we call “found money.”[/toggle]


Take a look at what we have seen in the past:

Reference the following diagram for a sample of mistakes that a chemotherapy coding audit can uncover:

drrs sample summary of findings-med_

The challenge becomes knowing how to structure a large amount of billing and clinical data in a way that will allow you to recognize the patterns and deficiencies.  While some of these coding mistakes can range from $20 to $100, we have seen mistakes occur into the thousands ($1,000 +) each.  The more data the better the result.

Why we recommend 1 years’ worth of data —

It takes a data pool large enough to make sure you’re eccompassing the critical areas.  Outside of timely filing issues, discovering mistakes over the past year is the most efficient way get the largest sum of money from this process.

Consider the following…

woman thinking-resized-600-small_

If you were having to move quickly down the ever-changing and dimly-lit path of oncology revenue cycle management, would it make sense to pay someone with a flashlight to stay behind and find money for you? Wouldn’t you want the best person for the job? What if I told you that you didn’t have to pay anything if that person didn’t find any money?  Now does it make sense to have them watching your back?

You need to have an expert looking backwards in the form of a chemotherapy coding audit in order to cover this area of your practice.  The possibility that you are just a few steps away from receiving thousands of dollars for which you have already worked is very real.

Either you put more money in your pocket, or you just keep going.

The choice is yours.






Author: NeltnerWebTeam