Should You Outsource to an Infusion Billing Company? A Critical Perspective

The search for an infusion billing company is probably as old as the specialty itself. Infusion services make up a critical aspect of modern day healthcare. The needle and the syringe have come a long way since they first appeared on the healthcare horizon. Today, infusion is a veritable specialty in itself, and no longer just a small important part of modern medication.

Infusion services are governed by their own set of billing rules, and there are many complexities that need to be handled efficiently in order to ensure maximum reimbursement by Payers (healthcare insurance providers). The intrinsically complicated nature of infusion billing is perhaps the chief reason why so many practices engaged in this line of work, seek the professional assistance of an infusion billing company.

Understanding the Challenges of Infusion Billing

In reality, the scope of infusion services is more than just skin-deep (no pun intended!) They are typically made up of different components encompassing drug administration, the type of infusion involved (such as hydration, therapeutic, chemotherapy), frequency of administering the medicine, dosage, and duration.

While billing for infusion services, many payers demand that a certain hierarchy is maintained while drawing up a claim. For example, infusion services pertaining to chemotherapy often take precedence over other types in billing.

Coding for infusion presents its own challenges. While the medication infused is billed separately using HCPCS codes, the service itself is coded using CPT codes. Some of the codes frequently used include:

Hydration Infusion

• 96360 – Used for initial intravenous infusion, hydration, lasting 31 to 60 minutes
• 96361 – Used for each additional 60 minutes

Therapeutic, Prophylactic, or Diagnostic Infusion

• 96365 – Used for initial intravenous infusion – such as in the case of administering antibiotics or steroids
• 96367 – Used for additional sequential infusion of a different substance/drug
• 96368 – Used in cases involving concurrent infusion

Chemotherapy and Biologic Drug Infusion

• 96413 – Used in chemotherapy IV infusion, for up to 1 hour
• 96415 – Used for every additional slab of 60 minutes
• 96417 – Used for additional sequential infusion

IV Push Administration

• 96374 – Used for the first IV push – single or first drug
• 96375 – Used for additional sequential IV push of a new drug

Further complexities that warrant assistance from an expert infusion billing company has to do with ensuring accuracy in billing. An example will help makes a little clearer. Many infusion codes are time-based. Strict and accurate data of ‘start’ and ‘stop’ times need to be furnished at the time of billing, failing which can quickly lead to claim denials.

Some infusion services are ‘bundled’ into a primary procedure. If a provider makes the mistake of billing separately for services which should be treated as one, unified set, denials – or even getting penalized for overbilling – can follow.

Prior Authorization and Infusion Billing – The Recipe for Disaster?

It’s a common plight. The struggle to get an infusion authorized by the payer can be a long and tedious one. While it is not impossible to get things done right the first time, securing prior authorizations for infusion services – especially the more expensive and complicated ones (like biologic drugs and chemotherapy) – can be truly challenging sometimes. Even the smallest slip in this regard can make your billing head for complete mayhem.

One of the most bothersome aspects of the pre-authorization process is the lack of uniformity. Private payers, Medicare, and Medicaid – they all have different reimbursement rates and rules, and keeping track of them all is a full-time job indeed. And that is just yet another reason why so many providers seek out the services of an infusion billing company. It just makes life so much easier for providers and patients alike.

Solving the Infusion Billing Riddle

It is evident that billing for infusion and injection services is akin to navigating a complex maze of myriad rules, details and caveats. The danger of getting a claim denied, or getting underpaid, lurks at every turn. The good news is, things don’t need to get this tough on everyone involved. In recent times, there has been a surge of interest in appointing the help of a professional infusion billing company.

A large, and rapidly growing, number of infusion practices and centers are offloading their billing responsibilities to these billing specialists with great results. Besides saving thousands in onshore recruitment or in-facility hiring, offshore outsourcing of billing activities to competent billing companies is fast emerging as a highly viable, sustainable and efficient alternative to traditional approaches.

For years, Sunknowledge Inc. has been helping infusion practices across the country streamline their billing operations, save on billing cost, and increase collections with their expert assistance. Effectively addressing every billing and coding challenge, Sunknowledge is dedicated to helping infusion practices focus more on their patients and worry less about collecting from insurance companies.

Don’t let infusion billing get under your skin (no pun intended, again!) Contact the experts at Sunknowledge today for a tailored solution to all your billing requirements.