Radiation oncology departments depend on accurate coding of claims to be reimbursed for their services. Inaccurate coding means no payment and possibly compliance issues that could raise a red flag. Almost all hospitals have a coding department, but that is not always the best solution when it comes to having expertise in radiation oncology (highly skilled certified coders trained specifically in radiation oncology to ensure that your ‘coding’ is done accurately).

There are many services out there stating they will check your radiation oncology charges for you. What exactly does that really mean? Looking at the EMR charges and comparing them against a treatment protocol template is not coding! We sometimes refer to this as “Charge Checks,”, and many times these types of services are done by non-certified billing staff (or software).

So, what are best practices when it comes to hiring a coding service? We have put together a list below to ask and research when you are looking at hiring someone to code your charges.

Questions to ask:

• Are there certified coders onboard trained in radiation oncology, and will the actual person(s) coding my charges be a certified coder?
• Is there treatment staff on board including, for example, radiation therapists and dosimetrists?
• Do you use software to check coding, and if so, what percentage of my coding will be dependent on software coding checks?
• Will all of my documentation in my EMR be checked against my charges (or just spot checked)?
• Do your coding services conform to currently applicable and published rules and guidelines issued by the American Medical Association, the Centers for Medicare, and Medicaid Services, and/or the World Health Organization and other copyright owners of coding formats?
• Do you fully comply with HIPAA guidelines at all times?
• If it will be necessary to enter charges into a billing software package, what will that costs be and what billing software packages are you familiar with (i.e., Allscripts, Epic, Cerner, AdvancedMD, NextGen, etc.)?
• What is your coding turn-around time?
• Do you audit your coding on a regular basis and can you produce such documentation?

In today’s world of CMS rules and regulations, just getting paid is no longer a guarantee of compliance. Having a coding service in place is like having a Gatekeeper between your documentation and what is billed out from your billing software. The return on investment is greater than what is paid for the service.  The peace of mind you’ll gain from knowing that your billing is complete, accurate, and in compliance is priceless!

Have questions? Contact us.