Healthcare entities delivering infusion therapy often tackle a unique set of challenges when it comes to billing and reimbursement. Evolving payer rules, complicated codes, and the time-consuming nature of managing claims all contribute to revenue loss or administrative backlog for various medical practices, specialty clinics, and infusion centers. Infusion billing services assist infusion therapy providers by providing accurate coding, facilitating the claims process, and enhancing financial outcomes.
As the area of infusion therapy continues to grow relative to chronic conditions, new biologics, and patient-centered therapies, more providers are exploring specialty billing partners to navigate this highly specialized area.
What is Infusion Billing So Complicated?
Infusion therapy takes place by infusion of medication administered either intravenously or subcutaneously. It is done frequently over prolonged time periods and possibly including additional monitoring or support services. Because of this complexity, the billing process is more than just submitting a claim and waiting for that claims to be paid.
Key factors of infusion billing complexity include:
Hospital-based Innovations
Infusion procedures can differ in length, sequence of administration, and type of medication infused. Proper documentation is important for identifying initial, subsequent, and concurrent infusion times, proving medical necessity, and other nitty-gritty details.
Drug-Specific Requirements
Many infused medications are expensive biologics with unique HCPCS codes, different rates of reimbursement, and stringent documentation requirements.
Frequent Policy Changes
As payers often change the rules for coverage, medical necessity, and documentation, ensuring compliance becomes vital.
Coordination
Infusion billing services require multiple stakeholders including the provider, specialty pharmacy, and insurance carrier. The complexity can result in claims management across multiple entities becoming increasingly complex.
These complexities can lead even the most experienced billing teams to fail to meet accuracy and efficiency without the right technology and expertise.
What do infusion billing services include?
An infusion billing service supports its clients by providing administrative support designed to optimize reimbursement and decrease administrative burden. Typical core services include:
Detailed Charge Capture
Accurate documentation on the duration of infusion, method of infusion, and supplies ensures that all potential billable services are captured. Accurate charge entry is the key to clean, compliant claims.
Insurance Confirmation and Prior Approval
Proper insurance confirmation in advance is critical to prevent unwanted surprises. Experts must verify coverage before proceeding with treatment. They must verify that the patient's plan provides for the prescribed infusion therapy. In addition, prior approval (PA) adds another level of complexity.
Providers must send details of the prescribed treatment to the payers to obtain authorization for the prescribed treatment. This includes submitting proper codes and completing extensive paperwork. In order to provide a proper PA, it will ensure network providers are reimbursed immediately for providing the treatment.
Expert Coding
Experienced coders assign the right CPT, HCPCS, and ICD-10 codes thereby reducing the risk of costly denial due to coding errors or inconsistency.
Claim Submission and Follow-Up
The infusion-billing team prepares and submits claims as per the latest guidelines. It ensures follow-up and expedites billing and payment.
Denial Management
Denials occur in the infusion billing process, but a strong specialty team identifies issues with root causes, appeals, and appropriate documentation that can strengthen the provider's position.
Foundations of Revenue Reporting
By partnering with a billing company, practices can be assured of ongoing transparent reporting of the billing period, allowing the practice to measure performance, trends, and revenue opportunities. All of these items work together to support timely infusion center revenue without delays.
Benefits of Outsourcing Infusion Billing Services
When it comes to infusion billing, there are multiple positive impacts of outsourcing that can lead to enhanced financial performance and patient experience.
• Higher Revenue
Billing specialists know how to code accurately, submit complete claims, and avoid simple mistakes that contribute to low collections. Providers frequently gain revenue after working with infusion billing companies.
• Diminished Administrative Workload
Infusion therapy professionals are often stretched between patient care, treatment planning, and administrative duties. By outsourcing the billing part, clinical teams can redirect their focus from paperwork and manage patient care.
• Enhanced Compliance
As payer rules change constantly, maintaining compliance can be difficult. Billing professional monitor and verify regulatory changes and ensures that all submitted claims are compliant with the latest regulations.
• Quicker Cash Flow
Timely reimbursement is a critical part of financial success. In addition, clean claims fast-track the cycle of reimbursement and ultimately improve cash flow.
• Improved Patient Experience
When benefits are verified accurately, the billing is completed seamlessly. Patients can experience fewer surprises along the way and a more continuous care model.
• Adaptable Solutions
As a practice grows, outsourced infusion billing services can be utilized in various ways like greater support during peak billing periods or serving under new treatment protocols.
Choosing the Right Infusion Billing Partner
It is important to choose the perfect billing company; however, not all vendors have the level of expertise for infusion billing. Consider the following factors for choosing the right billing company:
1. Experience in Infusion Therapy
A partner with previous experience in infusion billing will understand the nuances of time-based services, coding for specific drugs, and payer requirements for coding and billing.
2. Certified Coding Experts
Select a company that employs certified coding specialists who have infusion and injection coding experience.
3. Clear Reporting
Clear reports allow you to track your reimbursement flows and denial flows and the overall health of your revenue.
4. Proven Denial Management Processes
Appeal processes that are strong enough to demonstrate that the billing partner is capable of overturning denials.
Infusion therapy is an important service for patients managing any chronic illness, complicated conditions, or current treatment plans. But the administrative challenges associated with infusion billing can be overwhelming even for the most experienced medical teams. Infusion billing service providers can increase reimbursement accuracy and decrease the time it takes to provide reimbursement. Overall, it increases the overall financial health of the organization.
As the healthcare space continues to change, the need for patient solutions that are efficient and compliant becomes more of a necessity. Outsourcing infusion billing services reduced costs by up to 80% with hourly rates as low as $7. Investing in an outsourced professional billing company strengthens the revenue cycle and allows clinicians a greater opportunity to deliver excellent patient care.
Comments