Optimizing Infusion Billing Services for Better Practice Revenue

Infusion billing provides patients with an alternative way to receive medications, bypassing the gastrointestinal system. The process includes coding, billing, and reimbursement workflows. To be billable, infusion therapy must adhere to CPT code requirements, payer policy, and the multitude of regulatory billing systems in place.

In the outpatient setting, only one infusion service code is billed per patient, unless both an infusion and IV access are required for a single infusion procedure. In such cases, an infusion billing provider will utilize additional modifiers to identify the second IV access.

Infusion therapy is delivered in four main ways

1. An IV infusion is an injection of medication directly into the bloodstream. It is often used to treat patients who suffer from dehydration, infection such as pneumonia, cancer via chemotherapy, or chronic illnesses.

2. An epidural infusion is a process of providing medications, such as pain relief, to patients through the epidural cavity of the spinal column. The infusion is given around the spinal cord during labor and for the management of chronic pain.

3. Subcutaneous Infusion Therapy: It is used for providing medication that has a slow and drawn-out absorption rate by injecting it directly into the subcutaneous space. Some examples include insulin, biologic medications, and hormones.

4. Intramuscular (IM) Infusion Therapy: The process includes medication which is injected into the muscle, thereby drawing it in quickly, and used mostly for vaccines, antibiotics, and hormone therapy.

Infusion Billing: Common Challenges

Infusion billing is susceptible to several common problems, including complicated coding and documentation; inability to obtain prior authorizations; compliance issues associated with changing payer policies. Revenue loss and additional expenses for infusion providers often result from these issues.

Streamlining Infusion Billing

Infusion therapies are assigned to specific types of treatment, including multiple types of cancers, infections, and auto-immune diseases. Assuring that infusion therapies are billed correctly ensures that the insurance companies pay for and reimburse the infusion therapy provider as soon as possible which has to within 15-30 days. There are two main areas where infusion therapy billing processes can be improved.

Billing Knowledge

Infusion therapists are required to bill for the administered therapies by submitting all applicable codes for the types and purposes of infusion therapy. It is critical that the infusion therapists are well-educated and trained in bill submission that accurately represent the content of each infusion therapy, including the documenting of billable components related to a specific infusion therapy.

In addition to billing, infusion therapists are required to confirm the accuracy of the medication administration. It includes the dose and dosage units that are recorded and verified within the patient's record to provide assurance that the medications have been administered appropriately. Appropriate documentation of all completed infusions reduces the chance that claims will be denied due to inadequate or incomplete documentation.

Use of Technology

Infusion providers incorporate computerized billing systems to streamline routine infusion therapy billing functions. The automated functions assist infusion providers in identifying and correcting errors in coding prior to submitting claims for infusion therapy. Additionally, computerized billing systems allow infusion providers to be more effective at interfacing with electronic health records. This allows infusion clinicians the ability to focus primarily on providing quality care to their patients.

Infusion Claim Submission and Insurance Coverage Verification

Before submitting claims for infusion services, the billing experts should confirm that the patient's insurance covers the medication and that a pre-approval has been obtained from the insurance company. Claims submitted without verifying that the patient has insurance for the medication or without pre-approval may be denied.

Billing staff receive ongoing training on infusion-related coding updates, payer guidelines, and rules associated with the provision of infusion services.

Benefits of Infusion Billing Companies

Outsourcing infusion billing to a third-party billing company can help practices achieve better financial results through the following means:

Reimbursement

The billing specialist accurately records and submits all charges in one process, allowing for optimal reimbursement.

Reduced Denials

Skilled billing teams are knowledgeable about payer regulations and the compliance requirements for remitting insurance claims. As a result, billing teams are better able to submit compliant claims with less chance of claim denial.

Faster Payments

By actively managing claims from beginning to end, infusion billing companies can speed up the accounts receivable process and improve cash flow to the practice.

Streamlined Workflows

Infusion billing companies connects and integrates with the E.H.R. (Electronic Health Record) system, allowing infusion specialists to enter information once, thereby reducing administrative burden and eliminating redundancy of data entry.

Regulatory Compliance

Infusion billing companies are updated about the latest guidelines set by HIPAA and CMS to help practices maintain compliance with federal regulations, reducing the risk of audit penalties.

With outsourcing, practices can increase payment speed, optimize revenue, and significantly reduce operational cost. They can save as much as 80 percent, with rates starting as low as $7 per hour. It enables increased focus on patient care.

Why Outsource Infusion Billing Services

When infusion billing services are outsourced, healthcare practices can reduce the administrative burden associated with managing the administrative complexities. Outsourcing services to experts increases cash flow, lowers the number of claim denials and reduces payroll costs associated with administering these services.