In today’s healthcare landscape, infusion services are essential for delivering life-saving therapies to patients with chronic illnesses, cancer, autoimmune conditions, and more. Despite the complexity of these treatments, many providers face a persistent and often overlooked threat to their financial performance: under-coding.
Unlike over-coding, which can trigger audits and compliance risks, under-coding quietly erodes revenue, leading to significant financial losses over time. In infusion centers where drug costs and administration times are high, even minor coding discrepancies, such as missing drug units or incorrect time tracking, can translate into thousands of dollars in lost reimbursements each month.
At HealthRecon Connect, we partner with infusion providers to identify and resolve under-coding challenges at the source. Our specialized revenue cycle management (RCM) solutions are designed to detect coding gaps, enhance charge capture, and ensure that every service delivered is accurately documented, billed, and reimbursed.
What Is Under-Coding and Why Does It Happen?
Under-coding occurs when a provider reports fewer services, drug units, or time increments than were delivered during a patient encounter. It often results from unintentional errors or overly cautious billing practices in infusion services and can cause significant revenue loss.
Common causes of under-coding in infusion settings include:
- Incorrect or conservative drug unit calculations
- Missing or Incomplete documentation of infusion starts and stops times
- Omission of hydration, sequential infusions, or concurrent services
- Inaccurate reporting of drug wastage or multi-drug administration
- Confusion around J-codes and time-based CPT code sequencing
In many cases, providers under-code unintentionally, often out of caution to avoid triggering compliance issues or audits. However, this creates an ongoing gap between the services delivered and the revenue collected.
The Financial Impact: Thousands Left on the Table
Industry studies show that under-coding can lead to 2% to 5% in revenue leakage in outpatient infusion settings. For high-volume centers, even this small percentage can translate to tens or even hundreds of thousands of dollars annually.
Here’s a simple example:
An infusion center administers 800mg of a biologic drug but mistakenly bills for only 600mg due to a unit conversion error. At a reimbursement rate of $30 per 100mg, that’s $60 lost per infusion, amounting to $1,800 in lost revenue each month for just one drug. When this kind of error occurs across multiple medications and patients the financial impact adds up quickly.
In addition to lost revenue, under-coding can distort financial reporting. This makes it harder to forecast cash flow, negotiate payer contracts, and support strategic growth.
What Audits Reveal About Common Errors
External audits and internal reviews consistently uncover recurring patterns of under-coding in infusion services. These common errors include:
- Missing administration codes for pre- or post-infusion hydration.
- Failure to bill for sequential or concurrent infusions when multiple drugs are administered.
- Inaccurate or missing documentation of infusion start and stop times.
- Underreporting of drug units due to conversion or rounding errors.
- Incorrect or missing use of modifiers such as JW for drug wastage.
- Improper sequencing of CPT codes based on time intervals and drug hierarchy.
- Failure to apply modifiers for multi-drug therapy.
These findings highlight the need for robust documentation practices, coder training, and workflow integration to ensure full and compliant reimbursement for services provided.
How HealthRecon Connect Helps Fix Under-Coding in Infusion Services
At HealthRecon Connect, we partner with infusion providers to implement a proactive, technology-driven approach that ensures accurate and complete billing every time. Our goal is to close revenue gaps, reduce risk, and maximize reimbursements without adding an administrative burden to your team.
Here’s how we help:
- Expert Coding Review and Oversight
Our certified infusion coders are well-versed in J-code billing, time-based CPT logic, and payer-specific rules. We perform ongoing audits of submitted claims to catch under-coded services and prevent future revenue loss.
- Clinical Documentation Alignment
We closely work with providers to ensure accurate capture of infusion times, drug dosages, and waste tracking. Our team reviews infusion notes for completeness and guides clinicians on documentation best practices that directly impact revenue.
- Intelligent Charge Capture Automation
Our platform translates infusion documentation into optimized charge codes using automated workflows. This reduces manual errors, accelerates billing cycles, and ensures consistent reimbursement for every eligible service.
- Modifier Management and Compliance
Our system tracks the proper use of modifiers like JW (drug wastage) and 59 or 25 (for multiple services), ensuring correct application to avoid both over- and under-coding pitfalls.
- Training and Education
We offer ongoing education for providers and billing teams on infusion-specific coding changes, audit preparation, and evolving payer requirements. This helps your internal teams to be more confident and consistent.
Why Accuracy in Infusion Billing Matters More Than Ever
As reimbursement continues to tighten and payer scrutiny increases, infusion services must adopt a precision-first approach to coding and billing. Every missed drug unit or misclassified time increment puts your revenue at risk and can limit patient access to essential, life-sustaining therapies.
Let’s Optimize Your Infusion Revenue
With HealthRecon Connect’s tailored infusion RCM services, providers can protect their revenue, stay compliant, and refocus on what matters most: delivering safe and effective care.
Not sure if your practice is under-coding? Start with an infusion billing audit to uncover the revenue you may be missing. Our 90-day action plan delivers measurable improvements in claim accuracy, denial rates, and overall cash flow.
Contact us at sales@healthreconconnect.com
Learn more at www.healthreconconnect.com
References
- Billing and Coding: JW and JZ Modifier Billing Guidelines
https://www.cms.gov/medicare-coverage-database/view/article.aspx?=&articleid=53024&ver=21 - Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53049 - Billing and Coding: Hydration Services
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54635&utm_source=chatgpt.com - Revenue Cycle Management: The Art and the Science
https://pmc.ncbi.nlm.nih.gov/articles/PMC11219169/ - The 7 Deadly Sins of Infusion Center Documentation
https://www.accc-cancer.org/docs/projects/Financial-Advocacy/fan-the-7-deadly-sins-of-infusion-center-documentation - Top 3 Revenue Cycle Challenges for Health Systems in Infusion
https://www.prochant.com/resources/top-3-revenue-cycle-challenges-health-systems
