Reimbursement can be impacted by time-based coding, administration of the drug, rules for the payers, accuracy of documentation and prior authorization. Any little error can lead to a claim rejection or a payment delay of several weeks. By using proven Infusion Medical Billing best practices, infusion centers can submit cleaner claims, minimize unnecessary claim denials and keep their cash flow healthy.
Why Infusion Medical Billing Requires a Specialized Approach
When billing infusion therapy, there may be several HCPCS and CPT codes used for administration services and medications. Infusion length of time, method of administration, units of drug, diagnosis and medical necessity should be properly recorded and coded.
Payers can also have varying prior authorisation and claim submission criteria. The myriad variables involved in infusion therapy billing make it challenging without special expertise. Medical Billing professionals with experience and knowledge about infusion coding and payer rules can enhance the accuracy of claims and minimize claim errors that occur over and over again.
5 Infusion Medical Billing Best Practices for Faster Payments
Verify Insurance Eligibility Before Treatment
Verify active coverage, patient benefits, plan restrictions and infusion therapy coverage prior to treatment. Correct Eligibility Verification Best Practices prevents claim denial and unplanned patient out-of-pocket expenses.
Obtain Prior Authorization When Required
Numerous expensive medications that are administered via injection must be approved by the payer before they can be used. Ensure that all authorizations are in order and that the drugs are approved, the correct dosage, treatment dates, and the validity of the authorization to avoid denials.
Ensure Accurate CPT and HCPCS Coding
Proper procedure and drug coding are essential to proper infusion coding. Prior to the claim being submitted, the administration hierarchy, infusion time, units of medication and specific coding requirements for the different payers should be examined.
Maintain Complete Clinical Documentation
Documentation should be clear about the medical necessity and should provide the diagnosis, physician order, medication name, dosage, route, and details of treatment. Time-based services are charged by the second. If the service is time-based, then it is especially important to have accurate start and end times.
Submit Clean Claims the First Time
This can lead to delayed reimbursement due to incorrect patient information, missing authorization information, coding inconsistencies, or fields that are missing on claims. A pre-submission claim review or claim scrubbing can help increase first-pass claim acceptance.
How Outsourcing Infusion Medical Billing Improves Cash Flow
The infusion billing service experts offer distinct billing assistance in various areas such as eligibility verification, coding, claims submission, claims denial management, and A/R follow-up. Billing groups that are experienced with infusion billing know the particulars that impact infusion reimbursement and can identify billing issues early on.
Outsourcing Medical Billing can also mitigate the strain on in-house employees for growing infusion centers. Teams can now streamline their infusion revenue cycle management processes, rather than handling payer follow-ups and complex claim issues, and at the same time focusing on patient care.
Improved cash flow can be promoted by cleaner claims, quicker follow-up and effective denial prevention.
Why Choose Acuity Health Solutions for Infusion Medical Billing?
Acuity Health Solutions provides infusion centers, specialty clinics and healthcare providers with infusion medical billing services from start to finish. Our team provides advice on CPT, HCPCS and ICD-10 coding and verification of eligibility and prior authorization, submits clean claims, manages denials and follows up on A/R.
Our infusion billing software solutions are scalable to fit practices of all sizes, without burdening internal administrative tasks.
Want to boost your infusion reimbursement and simplify your infusion billing? Acuity Health Solutions’ solutions improve healthcare organizations’ revenue cycle performance, decrease billing inaccuracies, and speed up payments.
Frequently Asked Questions
What is infusion medical billing?
Infusion medical billing is the process of coding, submitting, and managing medical billing claims associated with the administration of infusions, as well as the medications and health care services provided.
What makes infusion medical billing more complicated than normal medical billing?
It includes documentation guidelines, drug units, CPT and HCPCS coding, and time-based guidelines and/or payer-specific authorization guidelines.
What documents are needed for medical billing when doing an infusion?
Diagnosis, medical necessity, physician orders, drug dosage, route of administration and time of infusion start and stop.
What benefits do infusion billing services bring for reimbursements?
Specialized billing teams help ensure claims are accurate, reduce denials, follow up on outstanding claims and ensure correct follow-up with payers for quicker reimbursement.
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