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Several years ago a stable radiation oncology practice decided to add medical oncology to their program. How hard can medical oncology be? Adding it made perfect sense, as the referrals would boost and solidify their radiation oncology program.

Luckily the full staff of stable, experienced medical oncology personnel transitioned to the new organization. Longtime nursing, pharmacy, certified coding and other billing personnel continued doing what they had always done, except now for their new employer. The pharmacy system and billing systems were reasonably good, but no charge capture interfaces were in place. Paper charge tickets were manually coded, manually accounted for, and manually entered line by line.

The practice engaged The Oncology Group to conduct a Revenue Recovery effort, and it’s no surprise that quite a few missed and incorrect medical oncology charges were identified and recovered. Every kind of possible error resulting from human involvement and manual processes had occurred, including missing charge tickets, missing charges, incorrect drugs and incorrect units (under- and overbilled). The corresponding revenue associated with the recovered charges was significant. Lost revenues would have been much worse had the staff not been trained and experienced in medical oncology.

Over time, feedback on missed charges contributed to the improvement of processes and training as well as increased charge capture and billing accuracy. There were still charge capture and billing errors made, however, due to the sheer volume of activity and the fast-paced environment.

Within a year a new billing system was implemented along with charge capture interfaces for drugs, lab and E&M services. Accuracy and speed improved exponentially. Although some missed and incorrect charges continued, the charge capture and billing process was working very well.

Then something broke! During a period of four to five months a significant amount of missed and incorrect charges occurred. Many of the incorrect charges related to new, high-dollar drugs that were grossly underbilled. How could this be happening?

It turns out that staff had turned over, including a couple of pharmacy techs and certified coders. The pharmacy techs were responsible for entering the correct drug information in the pharmacy system in order for the interface to pass correct charge codes and units. However, they were entering incorrect information. The certified coders were responsible for reviewing all charges against services provided before releasing the charges to be billed. But the coding review was not catching the big errors because of inadequate staffing and training.

As we all know, no matter how good a system may be, human input can still produce errors. The likelihood is much greater when processes are implemented manually and/or staff is inadequately trained.

Glitches in your coding and billing processes result in missed reimbursements—but they can be found and fixed. With our proven Revenue Recovery process, the experts at The Oncology Group can detect and address any flaws and help put more money back in your pocket. To learn more about how we can help, please contact us at 512.583.8815 or info@theoncologygroup.com.