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.
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Specific diagnosis codes
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Type and site of neoplasm (primary vs. metastasis)
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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:
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Illegible handwritten notes that omitted complete details of primary and metastasis sites.
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Difficulty identifying the neoplasm’s origin (e.g., whether metastasis was primary, secondary, or in remission).
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Frequent coding clarifications due to unclear documentation of malignancy extent, complications, or pain management services.
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Diagnosis codes lacking specificity, especially regarding primary, secondary, and overlapping sites.
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High denial rates caused by lack of clarity in documentation, resulting in revenue leakage.
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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
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Conducted detailed audits to ensure medical records supported high-level coding and accurate sequencing.
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Placed claims on hold when documentation was incomplete or lacked diagnostic specificity (e.g., unclear distinction between primary vs. secondary metastasis).
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Emphasized the importance of scanning detailed medical reports for more precise coding.
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Delivered targeted provider education on documenting:
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Cancer status and metastasis
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Complications and concurrent conditions
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Chemotherapy start and end times
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Comprehensive service details for timely filing and reimbursement
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Claims Tracking and Feedback Loop
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Monitored physician-specific trends and provided feedback on claims requiring additional details.
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Kept claims on hold until complete information was received, minimizing denials.
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Shared recurring documentation issues with providers in real-time to improve the clean claim ratio.
Results
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Streamlined Documentation: Accounts pending site-specific diagnosis dropped from 18% (Dec ’24) to 3% (Mar ’25).
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Improved Clean Claim Ratio: Issues with medical records were significantly reduced.
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Increased Collections: 15% improvement in collections – Average monthly collections grew from $161,000 to $172,800.
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15% improvement in coding accuracy
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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.