Oncology & Hematology Coding Alert

In the day-in-day-out battle to stay compliant with reimbursement regulations, oncology practices best tool remains the routine chart audit. Nevertheless, many practices especially the small- and medium-sized ones still refuse to perform checks of their billing habits because of the time and effort.

The way I look at chart audits, its a method to identify weaknesses in your reimbursement processes and procedures. You can use it to educate your physicians and staff, says Mike Lewis, healthcare consultant with Wheaton, Ill.-based Mathieson Moyski Celer & Co. CPA, an accounting firm that provides reimbursement services.

The publication of compliance guidelines for physician practices is another compelling reason for oncology practices to implement chart audits, says Elaine Towle, practice administrator for New Hampshire Oncology and Hematology, an oncology practice in Hooksett.

Similar voluntary compliance guidelines published by the Office of Inspector General (OIG) for other segments of the healthcare industry have recommended that providers implement systems to ensure billing accuracy and the reporting of billing errors.

Performing a chart audit is a straightforward process. Just follow these four easy steps:

1. Senior staff randomly selects a sample (at least 10 to 15 records per coder) each week and reviews them for accuracy. The auditors request copies of payment information for these claims to ascertain how the primary codes crossover to the APC assignments. At the same time, they review physician documentation, which allows them to
select which doctors need orientation on the new
requirements for outpatient coding.

2. The business office makes copies of the pages in
the Medicare remittances that illustrate claims where coding problems exist, sends these back to the coders, and possibly, the providers to address errors or deficiencies.

3. The facility documents outcomes and error rates,
then advises coders of errors and asks them to
review coding policies relevant to the errors.

4. Focused audits also may be necessary on hot
coding spots i.e., critical care, modifiers,
observation, high-end procedures, etc.

For oncology practices, the bulk of the audits should focus on evaluation and management (E/M) services. Further scrutiny of charts should include a review of common procedures and their documentation.

Many practices will find billing deficiencies that either garnered payment for services that arent supported by available documentation or services that were undercoded, Lewis says. Errors cant be corrected until they are found. Typically, oncology practices will find the following errors in their billing and documentation:

level-four and level-five E/M service claims not
supported by documentation;

billed consults that dont meet the criteria;

deficiencies in the medical record, such as missing
notations that would support medical necessity;

billing for chemotherapy administration performed
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