Oncology Billing Services

Drug and infusion billing, treatment planning and delivery coding, with the drug spend reconciled.

Oncology carries more financial risk in its drug cupboard than in its receivables. Chemotherapy and biologics are bought at real cost and given before anyone pays. So a J-code with the wrong units, or a missing NDC, is not a small billing error. It is the cost of the drug. Our oncology billing services reconcile drug given against drug billed every week.

Practices weighing up medical oncology billing services should also settle the benefit at contracting. Several payers now send high-cost drugs through a specialty pharmacy instead of letting you buy and bill. That changes the economics completely. Radiation oncology adds planning, simulation and delivery codes, each with its own frequency rules.

Our Services

Regulation Makes Oncology Billing Harder

Radiation oncology carries extra regulation, and the rules differ by state. That is why radiation oncology billing takes real expertise to run properly. Our oncology billing services give your practice a team that has it.

Key Attributes of Our Medical Billing Services:

  • Charge Entry

    Your claims come to us and go into our billing software. We hold accuracy above 98% within 24 hours. We get there by automating the routine steps, handling patient data carefully, checking eligibility and chasing insurers quickly.

  • Claim Scrubbing

    Drug claims are checked for J-code units and NDC reporting before submission. In oncology a units error is not a rounding problem. It is the cost of the drug, and it repeats on every cycle.

  • Insurance and Rejection

    Oncology rejections are mostly about authorisation. An approval that expired. A regimen change filed after the fact. Or a drug the payer wants routed through a specialty pharmacy instead of buy and bill.

  • Payment Posting

    Drug payments are reconciled against what the drug cost, for each administration. If an agent is paying less than you paid for it, you see that on the first cycle rather than the tenth.

  • Patient Statements

    Statements separate the drug, the administration and the physician service. They are held while financial assistance or manufacturer support is being applied.

    Illustration of a doctor writing a prescription for a patient

  • Optimize Efficiency

    We reconcile drug bought against drug given against drug billed, every week. In oncology an inventory gap and a billing gap look identical until somebody compares all three.

  • Timely Claim Submission

    Infusion claims go out within 48 hours of administration. Radiation planning and delivery codes are billed against the treatment calendar.

  • Reporting

    Reporting shows drug margin per regimen next to professional revenue, because in oncology those two numbers move independently.

Procedure

We bill this work every day. That includes, but is not limited to:

  • Contact x-ray Brachytherapy
  • Brachytherapy (closed source radiotherapy)
  • External beam Radiation Therapy
  • Intraoperative Radiotherapy
  • Deep Stimulation Breath-Hold
  • Systemic Radioisotope Therapy (Open source radiotherapy)

A course of radiation is billed in stages

Radiation oncology bills a sequence of distinct services across a treatment course, and the ones that get missed are the planning and management pieces rather than the treatments themselves.

Planning comes in levels

Clinical treatment planning is coded as simple, intermediate or complex, and the level is decided by the number of treatment areas, the dose considerations and the complexity of the volume. Billing every plan at the same level is both a compliance risk and, more often, an under-payment.

Simulation is a separate service, also levelled, and so is basic dosimetry. Intensity modulated planning has its own code and its own documentation expectations, and it is not billed alongside the standard planning code for the same course.

Weekly treatment management

Physician management during a course is billed per block of fractions rather than per visit or per week of the calendar. The requirements are specific: review of the setup films, review of the dose delivered, examination of the patient, and a note recording it. Practices that deliver the care and document it loosely lose these codes on review.

The block is counted in fractions delivered. A week with a machine down or a patient who misses days does not produce a billable block simply because seven days passed.

Image guidance

Image guided delivery is a separate service where it is performed and documented, and it is included in some delivery codes. Which applies depends on the technique billed, so this is checked against the current edits rather than carried over from last year's setup.

Where courses lose money

Two patterns account for most of it. Planning services performed before the authorisation was finalised and then never re-billed. And special services, such as a special treatment procedure or special physics consultation, performed for complex cases and never charged because they are not part of the routine template.

Oncology Credentialing and Infusion Center Enrollment

Oncology credentialing is really facility credentialing with physicians attached. The doctors enrol through CAQH and PECOS as usual. The centre is the harder half. A radiation centre or infusion suite has its own enrollment, its own accreditation and its own payer contracts. None of it moves on the physician timeline.

Drugs are the second problem. Buy and bill chemotherapy and biologics tie up real money before a claim is ever paid, so payers check the enrollment behind them closely. Some plans will only pay through a specialty pharmacy instead. Which route applies is decided in the contract, so it pays to know before you buy the drug.

We run physician enrollment, centre enrollment and the drug side together. See our medical credentialing services.