Infusion Billing Services

If the complexities of infusion billing services are getting in your way of submitting clean claims to the payers, you are at the right place. With our rich experience in providing complete support in pre- and post-billing for infusion services, Sunknowledge is your definitive destination for full assistance in A-Z of infusion billing.

Infusion services are not easy to handle. It requires adequate knowledge, constant awareness of changing codes and infusion billing experience. As when it comes to coding and billing for your infusions and injections, providers must follow the proper CPT guidelines, payer’s requirements various billing guidelines to ensure a seamless billing operation. The infusion and injection billing services are determined based on two factors- whether the services are reported by a physician or a facility. In most cases, physicians and facilities may report only one service code unless the patient’s condition or protocol requires two intravenous (IV) sites. The time and effort differences in providing the second IV site should be reported using the initial service code and an accurate modifier.

Managing infusion billing and coding services in fact is a great deal. You not only need to look after multiple aspects like specific billing requirements, covering the right CPT codes /HCPCS description, chemotherapy administration, infusion start/stop time, hydration infusions drug administration, IV push start/stop time but also various other limitations and exclusions in the medical records. Also it is important to know that drug administration codes are services that reference time and are “time based” codes

For a seamless infusion billing, a proper hierarchy should be maintained to support the bill and maximum amount of revenue. For example – Chemotherapy drugs come first, followed by therapeutic drugs, and then hydration drugs—the quantity of each is directly determined by the duration of the infusion.

How Can We Help?

Transform your Revenue Cycle with our legendary support at just $7/hr.* (all inclusive) guaranteed locked-in rate till 2026!

sunknowledge advantage

infusion billing

UNDERSTANDING INJECTION/INFUSION HIERARCHY FOR FACILITY REPORTING

Key challenges faced by most infusion centers in United States:

In the intricate domain of medical billing and coding, infusion coding, claims and AR stands out as a challenging area. With limited experience and knowledge in the healthcare industry, infusion professionals often face the following challenges-

  • Precision problem in coding duration
  • Documentation related to specific drugs
  • Navigating complex coding guidelines
  • Documentation complexity
  • Adherence to regulatory updates
  • Coding for different scenarios
  • Problems with infusion AR management

infusion billing

Some interesting infusion billing & coding facts-

  • When you bill IV hydration along with IV pushes, always report the IV push as the initial code.
  • According to the CPT hierarchy, the initial code must be 96374.
  • Following that code, 96361 must be assigned for the hydration.
  • The CPT hierarchy is based on the instructional notes found in the CPT book. You need to see parenthetical notes following both 96374 and 96361
  • Concurrent codes are not to be used for multiple drugs within the same bag
  • Typically concurrent is used for “gravity drip” infusion methods
  • 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour
  • 96361 Intravenous infusion, hydration; each additional hour (list separately in addition to primary code)

However, today with all these confusion, outsource your infusion billing practices is the best alternative solution. Outsourcing to the best infusion billing expert will not only help you save time but also reduce your claims denials rate and make your coding and billing process way easy.

And as you know that infusion coding requires substantial time and effort. And outpatient infusion coding requirements are more complex than in-patient setting. It is best to have dedicated resources managing your infusion coding services.

Sunknowledge: A comprehensive infusion billing and coding support:

With more than a decade of experience in the medical billing domain, we always ensure accurate and complete infusion and injection billing & coding operation. At Sunknowlege, we are highly equipped to provide timely and accurate infusion billing, coding, claims AR and more services to receive maximum reimbursement for your practice. Our team possesses comprehensive knowledge and expertise in managing various CPT, ICD-10, and HCPCS codes associated with infusion and injection, including the latest modifiers. Our certified coders consistently stay informed about the most recent guidelines and coding domain changes to provide you with accurate and up-to-date services. With nearly 17 + years of experience, we understand the intricacies of optimizing your entire medical billing infrastructure make us the best in the infusion domain.

Why us as your Infusion Support-

  • Timely and precise delivery of charge sheets within client-specified turnaround time (TAT)
  • Continuous monitoring, analysis of codes and timely claims management to prevent potential denials and ensure optimal reimbursements
  • Ongoing training for to stay updated with the latest infusion billing & coding advancements and current practices
  • Emphasis on a prompt report-back mechanism to facilitate efficient communication
  • All coders hold ICD-10 certification, showcasing their expertise and proficiency
  • Consistent maintenance of a 99.9 % coding accuracy rate
  • Adherence to 100% HIPAA compliance, prioritizing the security and confidentiality of patient information.

As a New York based leading RCM company, we enable you to slash your operational costs by almost 80 % in no time. 

Our Infusion Billing Service Portfolio:

Pre-billing Services:-

  • Eligibility Verification – Online & Calling (with same & similar check for Medicare)
  • Authorization Initiation – Online & Calling
  • Doctor’s Office Follow-up for documents etc.
  • Re-Authorization
  • Order Entry (Patient, Provider, Insurance, Item etc.)
  • Order Confirmation
  • Scheduling of Delivery 

Post-billing Services:- 

  • Creation of Claims
  • Claims Submission
  • Claim Rejection Management
  • Payment Posting – Auto & Manual
  • Accounts Receivable & Denial Management

If you are looking to streamline your infusion billing & coding services expenses while enjoying improved cash flow, we are your ready-to-go partner. If you want to know more about our services, schedule a no-obligation call with us.

FAQ’s on Infusion Billing

Why Should We Look to Outsource Infusion Billing?

While a patient receives a therapeutic infusion of a drug for one hour, specialized professionals know how to report CPT code 96365 for diagnosis, prophylaxis, or therapy. Finding in house team that knows it all can be difficult. Outsourcing of infusion billing reduces your operational costs, improves your focus on patient care, and transforms your cash flow.

Why will I Outsource Infusion Billing to Sunknowledge?

We offer seamless proficiency, great experience in working on infusion billing, and have excellent references across the industry. Sunknowledge delivers complete pre and posts billing support at $7 per hour reducing your operational costs by almost 75%.

Do You Work With Startup Infusion Billing Service Providers?

Yes, we have over 100 clients all across DMEPOS and infusion billing space. Our team is versatile and has the experience of working with startup sets ups as well as leading names. We offer dedicated resources and have a niche ability to work as your operational extension.

What are The Immediate Benefits if I Outsource to You?

We can reduce down your operational costs by 75%, improve collections by 30% to 40% within the first month itself, you can get access to an experienced team of medical billers ready to work for you at next door rates with seamless standards in communication. Also, we offer you dedicated account managers and customize according to your protocols.

How Soon Can We Start Our Infusion Billing?

We can start working immediately! After signing the initial scope of work, we will allocate your work to the concerned manager and his team. We will organize the transition, to understand your process and develop the manual which will be the point of reference for us during our working together. We also have a no binding contract.

Looking to know more about our infusion billing action plan! Let us share our best practices, references across the industry, and the ability to work as your reliable operational arm over a “no commitment call”! We are just a call away!

Are You Looking for streamlined medical billing assistance?

GET IN TOUCH

Enough of us! Lets know about your areas of interest! Get connected for a quick discussion on how we can elevate your revenue cycle management experience by working as a seamless operational extension.

    Input this code: captcha