Aranesp is a drug that oncologists use for patients suffering with anemia by helping the body produce red blood cells. 500 micrograms vial of Aranesp is priced approximately at $3,000 depending on where it is procured from. Medicare pays $3,500 for the same quantity of Aranesp. An oncologist needs to pre-purchase, store and administer drugs like Aranesp to take care of her patients. If the practice fails to report the patient’s hemoglobin count and hematocrit levels on the claim along with a relevant modifier (such as EA for chemo indused, EB for radio indused, or EC for non-chemo/ radio), Medicare will not pay. Other insurances tend to follow Medicare guidelines.

Consider another drug Zometa that costs approximately $xxx per vial. At the point of care, does your system remember whether you’ve administered this drug in the last 12 months? Insurance guidelines mandate usage of drugs like Zometa and Reclast for once in 12 months. If billed more than once they get denied.

An oncology practice needs to buy similar drugs in bulk, store them and administer them in a timely fashion to deliver care to patients suffering from a variety of cancer related ailments. If their reimbursements do not kick-in in time then they not only lose money for their services but they would also have paid to get a patient treated. A double whammy.

At NextServices, we acutely understand the specialties we work with and the nuances that determine reimbursements. For oncology, we use clinical guidelines that ensure appropriate billing occurs on the day of care. If we are not sure of a claim getting paid appropriately, we hold it and revert to the oncologist for complete and correct information before billing it out. It helps our clients in getting paid correctly and in turn allows them to focus on their patients.