Opening Remarks
Gary: Hello, everyone. Thank you for joining today’s session on outpatient infusion billing. Infusion billing is one of the most complex areas in healthcare reimbursement, and even minor errors can lead to significant revenue loss.
Today, we will explore:
- Why outpatient infusion coding is more complex than it appears
- Common billing mistakes that result in revenue leakage
- How automation can improve accuracy, compliance, and efficiency
About medaptus: At medaptus, we help healthcare organizations focus on patient care by leveraging technology to optimize billing and revenue capture.
Our solutions include:
- Charge Pro – A charge capture and reconciliation software used by hospitals for over 25 years
- Assign – A patient assignment tool for inpatient rounding and hospitalist organizations
- Charge Infusion – An automated coding solution designed to optimize outpatient infusion billing and eliminate manual errors
Speaker Introduction
I am the Director of Product Management at medaptus, responsible for the development of Charge Infusion, our automated coding solution for outpatient infusion billing. With 30 years of experience in revenue cycle management and medical coding, including a decade at Massachusetts General Hospital, I have seen firsthand how coding errors impact hospital revenue.
Understanding the Complexity of Outpatient Infusion Billing
Many organizations recognize the complexity of IV infusion billing in cancer centers, but infusions occur across multiple outpatient departments, including:
- Emergency departments (ED)
- Observation care units
- Specialty infusion centers
Key Challenges in Infusion Billing:
- Time-Based Reimbursement: IV coding depends on minute-by-minute duration tracking, unlike other procedures that have a simple CPT code
- Drug Type Hierarchy: Chemotherapy drugs take priority over therapeutic and hydration drugs, influencing billing order and reimbursement amounts
- Manual Coding Errors: Coders and nurses often struggle with the infusion billing hierarchy, resulting in underbilling or compliance risks
A difference of one minute in infusion time can increase or decrease revenue by $30-$100 per case.
Common Billing Mistakes in Infusion Coding
Through audits of healthcare organizations, we found that:
- Nine out of ten organizations had coding errors in outpatient infusions
- Error rates ranged from 35 to 75 percent per facility
- Hydration services were often underbilled or not billed at all
- Stop times for infusions were frequently missing, leading to revenue loss
Examples of Common Errors:
- Incorrect Initial Code Selection: The wrong starting code for chemotherapy, therapeutic, or hydration drugs leads to multiple cascading errors
- Missing or Inaccurate Stop Times: If a nurse enters “90 minutes” instead of 91 minutes, hospitals lose a billable unit, which can significantly impact revenue
- Overlapping Infusions Misbilled: If two drugs are infused concurrently, incorrect coding results in overcharges or lost reimbursement
One hospital audit revealed that nurses manually rounding down infusion times resulted in an annual revenue loss of $4.6 million.
How Hospitals Currently Address These Challenges
Hospitals typically try to fix infusion billing problems in three ways:
- Hiring More Coders – Expensive and inefficient, especially with coding shortages
- Relying on Nurses to Code – Nurses are not trained coders, and coding adds to burnout
- Manually Reviewing Documentation – Still prone to errors and delays
However, manual coding is not scalable. If an organization expands infusion services, it must also increase coding staff, which is neither cost-effective nor efficient.
The Role of Automation in Infusion Billing
To address these challenges, hospitals are increasingly adopting automation for charge capture.
Benefits of an Automated Infusion Coding Solution:
- Eliminates Manual Errors: Ensures compliance with coding regulations
- Improves Efficiency: Reduces the administrative burden on coders and nurses
- Optimizes Revenue Capture: Identifies missed billing opportunities and prevents undercoding
- Accelerates Charge Processing: Reduces charge lag, improving cash flow
At medaptus, our Charge Infusion solution integrates with electronic health records (EHR) to:
- Extract start and stop times automatically from documentation
- Assign the correct billing codes based on duration and drug type
- Ensure compliance with Centers for Medicare & Medicaid Services (CMS) guidelines
Case Study: Beth Israel Lahey Health
Beth Israel Lahey Health, a Massachusetts-based hospital system, implemented medaptus’ Charge Infusion solution to automate infusion billing.
Key Results:
- 90 percent of charges were processed automatically, with no coder intervention required
- Charge lag reduced by three days, improving cash flow
- Eliminated manual documentation errors, ensuring compliance and accuracy
Prior to automation, Beth Israel Lahey Health relied on manual charge capture, leading to inconsistencies and delays. With Charge Infusion, the organization saw significant improvements in revenue integrity and operational efficiency.
Conclusion
Outpatient infusion billing is inherently complex, requiring precise calculations based on drug type, duration, and administration route. Manual processes increase the risk of errors, impacting both revenue and compliance.
Automation provides a scalable solution, allowing hospitals to:
- Reduce coding errors
- Improve revenue integrity
- Free up clinical staff to focus on patient care
For hospitals looking to optimize infusion billing, automated solutions like medaptus Charge Infusion offer a proven way to enhance efficiency and ensure accurate reimbursement.
We hope this session provided valuable insights into the complexities of outpatient infusion billing and the role automation can play in optimizing revenue capture.
If you have any questions or would like to learn more about how medaptus can support your healthcare organization, please feel free to reach out and follow us on LinkedIn. We’d love to connect and discuss how we can help streamline your infusion billing processes. Get in touch.
