Prescribing Precision: How Codessence Cured Revenue Woes in an Oncology Practice
An oncology practice from Washington was experiencing significant challenges in its billing and revenue management processes. Despite providing high-quality care to their patients, they were facing revenue leakage due to coding issues and administrative errors. The complex nature of chemotherapy administration and the evolving guidelines made it difficult to code and bill for services accurately. As a result, they were experiencing denials and underpayments.
Quintessence Findings
- Incorrect Sequencing of Infusion and Injection Codes: Due to the complex hierarchy of chemotherapy administration codes there were challenges in accurately sequencing infusion and injection codes. This led to difficulties in properly coding and documenting the order of administration, potentially resulting in claim denials and underpayments.
- Missed Bundled/Packaged Services: The inclusion of bundled services and items associated with chemotherapy administration, such as local anesthesia, IV access, flushes, and standard supplies, was often overlooked. This oversight resulted in incomplete billing and revenue leakage as these services were not appropriately accounted for in the coding and documentation process.
- Inadequate Documentation for Anti-Neoplastic Agents: Insufficient documentation was provided for non-cancer diagnoses or substances like monoclonal antibody agents and biologic response modifiers used in non-cancer conditions. This lack of detailed documentation made it challenging to accurately code and document chemotherapy administration, potentially leading to coding errors and inaccuracies.
- Inconsistent Reporting of Hydration Services: Determining whether hydration services should be separately billed or considered an integral part of chemotherapy administration posed difficulties. The ambiguity surrounding the reporting of hydration services resulted in billing errors and potential revenue loss as the appropriate coding and documentation for these services were not consistently applied.
Solution Plan:
Quintessence proposed a comprehensive solution to address the challenges faced by the Oncology Practice.
- Implementation of an ML-based Coding Platform: Quintessence introduced an advanced Machine Learning (ML) based coding platform Codessence, specifically tailored for oncology billing. This platform utilized a rule engine to ensure accurate and compliant coding, eliminating coding errors and reducing denials.
- Real-Time Coding Guidance: Codessence provided real-time guidance to the Coding team, incorporating the latest coding guidelines, bundling rules, and hierarchy requirements. This enabled the team to code with precision and maximize reimbursement for services provided.
- Automation and Workflow Optimization: Quintessence automated various aspects of the billing process, including documentation review, code assignment, and claim submission. By streamlining workflows and minimizing manual interventions, the platform reduced administrative burdens and improved overall efficiency.
Implementation:
- Rule Customization: Quintessence worked closely with the practice to customize the coding rules and ensure alignment with the practice’s specific requirements and payer contracts.
- Coding Automation: With Quintessence’s Codessence the practice trusted us with their end-to-end RCM. With our Hybrid model, every chart was coded with the highest accuracy. The best part is Codessence is integrated with the practice’s Billing system and claims are submitted automatically.
- Testing and Validation: The ML-based coding platform underwent rigorous testing to verify its accuracy and effectiveness in real-world scenarios. Quintessence collaborated closely with the practice to validate the results and fine-tune the system as needed.
