In oncology the drug costs more than the visit. One denial hurts.
Buy and bill margins are thin enough that a single unpaid infusion can wipe out the profit on many others. Authorization and unit accuracy are not administrative details here.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Oncology claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Drug units and wastage miscounted
Drugs are billed per unit with wastage reported separately. A miscount on an expensive agent is a direct loss, not a reduced payment.
- Authorization not in place before administration
Regimens need approval before the chair is booked. Administered without it, the drug is a cost you have already paid for.
- Infusion hierarchy applied incorrectly
Initial, sequential and concurrent infusions follow a strict hierarchy and are timed. Coded out of order, the whole session underpays.
What we bill for Oncology practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Oncology accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- An oncology coder, not a general one
The coder assigned to your account works oncology every day. They already know which of your payers do what, and they are watching drug units and wastage, authorization and infusion time hierarchy.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in oncology it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your oncology claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Oncology practices
- Coders who work oncology daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Oncology billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Oncology service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Oncology practices ask
How do you protect buy and bill margin?
By getting authorization in place first and the units right second. Those two account for most of the loss.
Do you report wastage?
Yes, on its own modifier, with the amount documented.
Can you separate clinical trial billing?
Yes. Research and standard of care have to be split or it becomes a compliance problem.
Do you handle radiation oncology?
Yes, as a treatment course with its own planning and delivery codes.
Have an oncology coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.