rcm solutions Hematology / Oncology facilities

Medical Billing And Revenue Cycle Management Solutions For Hematology/oncology Facilities

Hematology/Oncology is a medical specialty that deals with the diagnosis, treatment, and prevention of blood diseases and cancers. At StafGo Health, our team has comprehensive knowledge of the complexities involved in Hematology and Oncology billing. From complex treatments and therapies to complicated procedures like chemotherapy administration and complex drug billing, every detail is coded and submitted correctly. To succeed, the practice requires accurate coding for specialized procedures in this competitive world of healthcare.

Master Of CPT Code Management For Hematology/oncology Facilities

To get proper reimbursement, it is essential to use accurate codes. Hematology and Oncology billing consists of a wide range of complex procedures and therapies that require accurate coding to ensure clean claims submissions and faster reimbursements and our efficient coding management involved the correct use of all the commonly used CPT codes in this specialty, including 96413 (chemotherapy administration, intravenous infusion, up to 1 hour), 96415 (each additional hour), 96372 (therapeutic or diagnostic injection), and 96365 (initial infusion, non-chemotherapy), and HCPCS codes such as J9190–J9999, which are used to bill for specific chemotherapy and supportive care drugs.

Why Outsource Medical Billing And RCM To Stafgo Health For Your Hematology/oncology Practice?

Various factors need to be taken into account in the proper billing of hematology/oncology, such as multiple units, drug dosages, and time-based services, which make revenue cycle management very challenging. Hence, outsourcing medical billing and revenue cycle management (RCM) to StafGo Health offers hematology and oncology practices a strategic advantage in navigating the complexity of cancer care billing.

Common RCM Challenges Faced by Hematology/Oncology Practices

Hematology practices encounter multiple billing challenges due to being a highly specialized area of care with unique billing complexities and operational inefficiencies. Some of the challenges involve-

Complex Billing Requirements and Coding Errors - Complex CPT, HCPCS, and ICD-10 codes are used in Hematology/Oncology for different complex procedures like chemotherapy, infusion, and supportive care services. Error in the application of these codes can result in claim denials or underpayments.
Authorization and Pre-Certification Complexities— Many procedures in hematology/oncology, such as chemotherapy, diagnostic testing, and biologic infusions, require prior authorization and certification. Delays in getting these can lead to delayed patient care and can also impact cash flow.
Frequent Payer Policy Changes - Policies for oncology drugs, infusion billing, and coverage limitations are subject to change frequently. Staying updated with the current changes is crucial to prevent denials and reduce rework.
Costly Denials and Reimbursements - Some denials are very costly, related to experimental drug codes, improper bundling, or missing documentation, and can lead to significant loss of revenue if not managed properly and quickly.
High Patient Financial Responsibility - Sometimes, practices have to struggle with collecting patient balances due to a rise in co-pays, deductibles, and coinsurance for oncology treatments. This leads to denials or underpayments.
Underpayments and Variance in Contract- Oncology practices often experience underpayments due to payer discrepancies with contract terms and thus require regular monitoring and appeals.

Solving Your Hematology/Oncology Practice’s Challenges with StafGo Health

Coding and Modifier Accuracy—At StafGO Health, our certified coders are trained in the application of complex oncology codes, including CPT, HCPCS, and ICD-10, and make sure that claim submission is accurate and your practice gets maximum reimbursement from the start.

Proactive Authorization Management - Our team works proactively to handle prior authorizations and pre-certifications for chemotherapy infusions, diagnostics, and high-cost treatments. It reduces the service delays and patient frustration.
Denial Prevention & Rapid Appeals- Our team of experts monitors the insurance and payer trends, tries to find root causes of denials, and makes strong appeal documentation to recover revenue promptly.
Customized Reporting & Real-Time Dashboards- Our skilled team can make transparent, easy-to-read financial and operational dashboards that can monitor and track charges, payments, denials, and collections so that your practice can make informed decisions proactively.
Patient Billing Support & Collections - We provide clear information about patient statements, set up payment plans, and also provide dedicated support to help your patients understand their balances
Regulatory Compliance & Audit Readiness - Our team makes sure that your billing processes are aligned with payer guidelines and government regulations, which help your practice stay audit-ready and compliant at all times.