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Medical oncology auditing – a must for every practice


Auditing your practice’s medical billing is essential to finding those missed opportunities which could lead to increased revenue. An audit can check for incomplete or inaccurate billing practices, for example the audit can find services provided within the medical records that were not charged, and subsequently not reimbursed.

Auditing a practice’s billing to ensure they are billing for all chemotherapy units (missed and wasted), using appropriate modifiers, and ensuring that proper administration codes are used. The audit will look for trends over month-to-month, yearly and benchmark against similar practices within your specialty (regionally and practice size). In addition, the audit will look at CPT codes to ensure your payers are accurately reimbursing based on your contract.

Many of these issues can be detected when edits have been created in electronic medical record (EMR) or practice management (PM) systems. The edit will highlight to your billing staff when more information might be required so the claim is not denied or when collections are taking longer than stated in your payer contract. Not all edits placed into your systems may be applicable in every situation, but it will highlight potential opportunities.

In addition, after the audit, the consulting team can inform your practice administrator if your nurses (who are possibly not familiar with ever-changing billing codes) or billing staff (who may not understand concurrent charges or documentation as noted in the records) need to be trained for improved management of billing.

While some business analytic systems, like InfoDive®, can help to check for missing units of drugs, your practice needs to understand how those missed drugs are attributed – through waste or improper attribution of units.

To learn more about how the business consulting team can partner with your practice to highlight those opportunities to increase revenue, contact