Authorization mismatches
Drugs denied because the regimen changed after authorization. We track authorizations against the active regimen and update before infusion.
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Oncology medical billing services
Oncology is the highest-stakes billing in outpatient medicine: expensive drugs, complex infusion coding, prior authorizations on nearly everything and payers that audit closely. A missed authorization or a unit error can cost more than a month of visits.
What makes oncology billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether oncology claims pay the first time.
- Chemotherapy administration (96401–96549) follows a hierarchy of initial, sequential and concurrent codes with time thresholds.
- Every drug needs the right J-code, units converted from the dose, and wastage documented with JW or JZ.
- Prior authorization is required for most regimens and for supportive drugs; changes in regimen require new authorization.
- Radiation oncology, if provided, has its own code set with treatment planning, simulation and delivery codes.
Denials we see most in oncology
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Unit and wastage errors
Drug lines denied or underpaid. Units converted per code; wastage modifiers applied.
Administration hierarchy
Infusion codes denied for incorrect initial and sequential logic. Applied from the infusion record.
How Core MB bills for oncology
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new oncology providers runs in the same system, tracked live in your client portal.
- Authorization management tied to the treatment plan, updated when regimens change.
- Drug and administration billing verified from the infusion record.
- Buy-and-bill margin reporting by drug.
Everything in the service
The full revenue cycle as standard for oncology practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Oncology billing questions
Why is oncology billing so unforgiving?
Because the dollar amounts are large and the rules are specific: authorizations per regimen, units per J-code, wastage per payer. One error on a drug line can cost thousands, so every line is verified.
Do you track authorizations when regimens change?
Yes. A new drug or a dose change often needs a new authorization, and we update before the next infusion rather than after the denial.
Can you tell us which drugs are profitable to infuse in-office?
Yes. We report reimbursement against acquisition cost by drug so you can make buy-and-bill decisions on data.
How do we get started with Core MB for oncology billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new oncology providers can start at the same time.
Find out what your oncology billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.