How many times have your patient statements gone out and within just a few days, your phone goes crazy?
On the other end, accusatory voices say such statements as:
“I checked my calendar and I was not in the office the days that are on my bill!”
“I was charged for treatment, but I haven’t even started my treatment yet!”
The Fallout from Medical Billing Fraud
Due to the bad apples in the healthcare industry, medical billing fraud is a hot topic around the country and rightfully so. Unfortunately, it has the tendency to raise the suspicions of patients to an almost feverish pitch.
Anyone involved in billing for Radiation Oncology services is familiar with a unique situation that we encounter frequently. Due to the nature of radiation therapy treatment planning, numerous medical procedures are performed “behind the scenes” without the patient actually present in the office.
In addition to charges for “hands on” activities, the patients’ accounts frequently have charges that represent a more intellectual type of work performed by the physicians, dosimetrists and medical physicists.
This work includes the radiation therapy treatment orders or prescription, the creation, review and QA of the treatment plan, etc. The most common HCPCS codes that generally are used for these services are: 77261-77263, 77470, 77295, 77301, 77300, 77305-77315, 77332-77338, 77293, 77321.
Ensure the Accuracy of Your Radiation Oncology Billing
Iridium Suite Medical Billing Software contains advanced code capture import capabilities. You can bring in charges and patient demographics from a variety of sources: Aria and Mosaiq Record and Verify Systems, Oncochart EHR, and with our Connectivity Clearinghouse, HL7 files can be imported from any HER system.
What is the best way to deal with these of patient inquiries?
“I checked my calendar and I was not in the office the days that are on my bill!”
Patients often will accept a pretty basic explanation of this situation. You can simply point out the nature of radiation therapy treamtent is very technical and complex. In order to provide the appropriate safe treatment, a plan must be written by the physician and created and reveiwed very carefully by the physician and support staff.
Each of these procedures has a corresponding charge. Their insurance understands that that the patient does not need to be present for these services . You can always encourage them to discuss this directly with their customer service representative.
“I was charged for treatment, but I haven’t even started my treatment yet!”
As a biller, you know that most procedure codes have fairly long descriptors/definitions. They are always much longer than the space that can be allotted on a patient statement or the explanation of benefits sent to the patient from their insurance company. Many of the above codes contain the word “treatment” in their description, so the abbreviated version the patient sees, can really cause some confusion then accusations.
For charges 77261-77263: They can be told that this represents the prescription that the physician completes in the medical record for their specific course of treatment. It contains the dosages and number of treatments and treatment areas that are used in preparation for their therapy.
You should emphasize that the codes that represent the preparation of the treatment plan (77295, 77301, 77300, 77305-77315, 77293, 77321) and the treatment devices, (77332-77338) represent numerous hours of work on the part of the physician, dosimetrist, and physicist. They utilize their vast knowledge in creating the best plan for the patient. This plan is what is used to actually administer the radiation treatments.
If you have a particularly “tough customer”, you can always offer to provide them with a copy of the document that represents these procedures.
The records will most assuredly be well “over the head” of a typical patient. Historically, just offering a copy of this portion of the medical record will typically be assurance enough of the legitimacy of the charge.
In the “old days” of paper charts, just a quick demonstration of the amount of paperwork in their file usually appeased them pretty easily. An electronic file does not have quite the same impact.
Medical bills are confusing to most, and for those with serious conditions like cancer, can definitely be overwhelming. By listening to their concerns and then addressing them in a calm and confident manner, your patients will be able to understand the extenuating circumstances of the Radiation Oncology billing process.
This goes a long way in collecting patient balances and fostering a good reputation for your medical practice.
