Case Study: Improving Reimbursement Accuracy Through Comprehensive Oncology Documentation
Customer Situation
An Illinois-based oncology practice was experiencing frequent denials and delays in reimbursement due to incomplete and unclear documentation. Providers relied heavily on handwritten notes, which often lacked critical details such as:
Specific diagnosis codes
Type and site of neoplasm (primary vs. metastasis)
Complications, prognosis, and relevant history
As a result, coders struggled to assign accurate codes, leading to rejections, delayed billing, and increased accounts receivable (AR) days.
Challenges
Our audit identified several documentation and process-related issues:
Illegible handwritten notes that omitted complete details of primary and metastasis sites.
Difficulty identifying the neoplasm’s origin (e.g., whether metastasis was primary, secondary, or in remission).
Frequent coding clarifications due to unclear documentation of malignancy extent, complications, or pain management services.
Diagnosis codes lacking specificity, especially regarding primary, secondary, and overlapping sites.
High denial rates caused by lack of clarity in documentation, resulting in revenue leakage.
Delays in billing due to excessive back-and-forth with providers, contributing to charge lag and longer AR days.
Solution
The practice outsourced its billing processes to MBW RCM. We implemented a comprehensive revenue cycle transformation plan that addressed both provider documentation and coding accuracy.
Medical Records Audit
| Best practices in Oncology Coding |
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Conducted detailed audits to ensure medical records supported high-level coding and accurate sequencing.
Placed claims on hold when documentation was incomplete or lacked diagnostic specificity (e.g., unclear distinction between primary vs. secondary metastasis).
Emphasized the importance of scanning detailed medical reports for more precise coding.
Delivered targeted provider education on documenting:
Cancer status and metastasis
Complications and concurrent conditions
Chemotherapy start and end times
Comprehensive service details for timely filing and reimbursement
Claims Tracking and Feedback Loop
Monitored physician-specific trends and provided feedback on claims requiring additional details.
Kept claims on hold until complete information was received, minimizing denials.
Shared recurring documentation issues with providers in real-time to improve the clean claim ratio.
Results
Streamlined Documentation: Accounts pending site-specific diagnosis dropped from 18% (Dec ’24) to 3% (Mar ’25).
Improved Clean Claim Ratio: Issues with medical records were significantly reduced.
Increased Collections: 15% improvement in collections - Average monthly collections grew from $161,000 to $172,800.
15% improvement in coding accuracy
13% reduction in client queries/feedback reducing rework.
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Our focus on resolving denials by identifying and systemically eliminate the root causes, helps our clients improve revenue by a minimum of 20%. To learn about how we can help you reduce denials and improve revenue cycle metrics, please fill the form below, and we will be in touch.
