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Fear of audit, lazy billing erodes profits

Fear of audit, lazy billing erodes profits

Hard-working community doctors may lose valuable cash flow if they undercode for services. But that is just what many oncologists do, generally out of fear of penalties for overcoding.

In many instances, coding for less than services rendered, or for more than what is allowed, is symptomatic of sloppy billing practices. It pays to learn how to code accurately. Here are a few tips that can help keep your practice in the black.

New patient, get new info

As soon as you take on a new patient, verify his or her insurance information and authorization. Your back office should have standard verification procedures to confirm that your patient has obtained any needed referral.

Practice management experts strongly suggest preregistering new patients by phone; in-person registration can result in errors if the registration desk is particularly busy that day.

Preregistration also allows the staff to verify coverage with the insurance provider before the first visit.

Be sure to collect copayments at the time of service—sharply rising copayments mean that the patient’s portion could be quite substantial. Remember, collecting from the patient in person affects the overhead costs of billing and enhances cash flow. For cancer patients, the copayment amount may not be known until after the physician sees the patient, so set up the collection process at the end of the visit.


Have your office manager file daily claims electronically. It’s the trend, and for good reason. Electronic claims are processed faster than paper claims, and fewer electronic claims are denied. A 2006 survey by America’s Health Insurance Plans found that 69% of clean electronic claims were processed within a week, compared with only 29% of clean paper claims.

Clean code

If you really want to spruce up your billing process, use an electronic claims scrubber. There are a number of software products and online tools that will scrub for errors to varying degrees. Some check only for generic errors such as incorrect ZIP codes or days of the month. More sophisticated programs check for required prefixes or suffixes in insurance identification numbers. They also may have the capacity to check compliance with Medicare’s Correct Coding Initiative. However, your practice management system may have a built-in scrubber module that incorporates compliance-related edits.

Discuss options with your software vendor to find the right add-on program or Web-based service for your practice. Practices that put in the effort to clean up their coding have reported denial rates of less than 1%.

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