With the advancing Advance Payment Model (APM) becoming a reality in 2022, many radiation oncology centers are seeing a shuffle of resources trying to get ready for the inevitable. The APM is designed to increase the quality of patient care by rewarding high-value patient care (quality versus volume). One of the factors that can affect your APM payment is your coding accuracy (or lack of).

Your documentation must support the level of services you are billing in radiation oncology. Many times in audits we find that documentation is incomplete or unsigned, the diagnoses do not match the current treatment site, and the E&M level chosen is not supported by the note in the chart. One common issue we find is the physician forgets to dictate immobilization in the physician sim note (when the therapist has a separate note). Another issue is using template forms that contain the same language (with just a patient name change).

Almost always, a coder used as a Gatekeeper can increase your level of charge accuracy and at the very least point out your deficiencies so you can correct them. Below are the top three reasons we think coding is so important in any radiation department.

1. Reduced denials for services provided = less time spent by your billing staff working the Accounts Receivables (AR).
2. Compliance – if you are ever audited, having a Gatekeeper Coder is a great step in your compliance plan. Even better is the chance of ‘not’ getting audited if your claims are correct, to begin with.
3. Increased revenue through correct coding. Many times, money is left on the table by providers simply because they don’t know they can bill for certain services, or they are simply missing charges.

The amount of money you pay for a Certified Coder or Coding Service is small compared to the return on investment (peace of mind). Having a Gatekeeper between your EMR system and your billing software is a no-brainer, especially in the changing healthcare environment we live in today.

Contact Radiation Business Solutions to learn more about our coding services.