Oncology Invoicing Software

Invoicing in a Oncology Practice

Most oncology revenue arrives through insurance claims, but a lot of billing happens after them. Once Medicare and any supplement have paid on an infusion, the patient may still owe coinsurance on a costly drug. An oncology invoice has to show that balance clearly: what was billed, what each plan paid, what copay help covered and what is left. Patients can get the invoice by email or text and pay with a saved card or a payment plan. Some balances should never reach the patient at all. QMB patients can't be billed Medicare cost sharing, so that amount goes to the state Medicaid program. Clinical trial patients bring a different split. Routine care can be billed to insurance, but items paid by the sponsor or done only for the study can't. Oncology invoicing holds those charges off claims and patient invoices, and staff list them in a report to bill the sponsor under its agreement. Self-pay patients get invoices that staff compare against the estimate they were given.

Why Is Invoicing Different in Oncology?

Patient balances in oncology are large and confusing. A single treatment day may have several drug lines, each paid at a different rate, with a supplement and a copay program paying parts of what's left. If the invoice shows one total with no detail, patients call the office or stop paying. Invoicing for a cancer practice has to explain the balance line by line in plain words.

Assistance makes the math harder. Manufacturer copay programs and independent charities each pay on their own terms, often after the claim has been settled. A charity grant may cover some drugs and not others, or run out partway through a regimen. The invoice must show which help was applied, which is still pending and what the patient truly owes today.

Clinical research adds bills that are not insurance claims at all. Medicare covers routine costs in qualifying trials, but not items the sponsor pays for or tests done only for the study. Those costs belong to the sponsor under the trial agreement. If they slip onto an insurance claim, the practice faces a compliance problem, so oncology invoicing has to hold research charges off insurance claims and patient invoices and list them in a report for sponsor billing.

What Oncology Invoicing Software Handles

Sponsor-paid items in clinical trials

Under NCD 310.1, routine costs don't include items the sponsor customarily provides free, or items done only for data collection. Staff hold those charges off insurance claims and list them in a report, and the sponsor is billed from that report under the trial agreement. (CMS National Coverage Determination 310.1: Routine Costs in Clinical Trials)

Investigational items

NCD 310.1 also leaves out the investigational item itself unless it is covered outside the trial. In invoicing, staff hold a study drug supplied for the trial off the patient's insurance claim and off the patient's invoice. (CMS National Coverage Determination 310.1: Routine Costs in Clinical Trials)

QMB cost sharing

Providers must accept the Medicare and any Medicaid payment as payment in full for a QMB patient. Staff hold invoices for QMB patients with a rule the practice sets, and the cost sharing is billed to the state Medicaid program instead. (CMS MLN7936176: Prohibition on Billing Qualified Medicare Beneficiaries)

Good faith estimates for self-pay care

A patient who isn't using insurance must get a good faith estimate, and they can't dispute a bill without one. Self-pay invoices are compared to the good faith estimate on file before they go out. (CMS Medical Bill Rights: Good faith estimates)

Independent charity grants

OIG allows independent charity programs to help federal program patients when they meet its guidance. Grant payments are applied as credits on the patient invoice, with the fund named, so patients see what the copay assistance program paid. (Federal Register: OIG Supplemental Special Advisory Bulletin, Independent Charity Patient Assistance Programs (2014))

Reduced coinsurance on rebatable Part B drugs

Some Part B drugs carry a lower coinsurance in a given quarter under the Medicare inflation rebate program. The patient's share on the invoice reflects the coinsurance Medicare applied on the remittance for that quarter. (CMS: Medicare Inflation Rebate Program (Part B coinsurance adjustments))

How Does Oncology Invoicing Software Work?

1. 1. Wait for every payer

   A patient invoice is built only after the primary and secondary payers have paid, as tracked in oncology medical billing. Any balance still pending with a payer stays on hold.

2. 2. Apply copay help

   Manufacturer and charity payments are applied as credits on the right drug lines. Pending help is noted, so the patient isn't billed for an amount a program will pay.

3. 3. Send a clear invoice

   The invoice shows charges, payer payments, credits and the balance in plain words. Patients get it by email or text, with a link to pay.

4. 4. Collect and post

   Payments by card, saved card or payment plan post straight to the ledger through integrated payments for oncology. Plans can be set up for large drug balances.

5. 5. Track research charges

   Staff hold research charges off insurance claims as oncology charge assembly builds them, and list them in a report. The sponsor is billed from that report under the agreement, and staff track payment.

Oncology Invoicing Software vs. Generic Software

Who Uses It in a Oncology Practice

• Patient account rep: Invoices patients can read, with copay help shown, so calls are about payment plans instead of confusion.
• Research coordinator: Research charges held off insurance claims and listed in a report for sponsor billing under each trial agreement.
• Financial counselor: A view of which help has been applied and which is pending, before a balance reaches the patient.