From chemotherapy infusion hierarchies to J-code drug claims and prior authorizations, our certified oncology coders keep claims accurate and payments moving, so your practice can focus on patients, not paperwork.
Oncology is one of the most complex and highest-cost areas in medical billing. A single treatment cycle can involve drug acquisition, infusion services, radiation planning, lab work, and supportive care, each with its own coding rules and payer requirements. One missed unit, wrong NDC, or expired authorization can put thousands of dollars at risk. We build your revenue cycle around these realities so complex treatment plans become clean, collectible claims.
Cancer treatment runs for months or years, which means claims, authorizations, and patient balances stay open far longer than in most specialties. We track each one from the first consult to the final follow-up.
We bill injectable drugs with correct HCPCS J-codes, units, and NDC numbers, and apply JW and JZ modifiers for discarded drug amounts, so you recover the cost of expensive single-dose vials without triggering audits.
We manage authorizations for chemotherapy, immunotherapy, and radiation, track expiration dates, and flag regimen changes before treatment.
We link ICD-10 diagnoses to cancer type, stage, and line of therapy, and match them to NCCN guidelines and payer policies so drug and procedure claims hold up on review.
From diagnosis to survivorship, we code and bill the services oncology practices deliver every day.
Correct sequencing of 96413–96417 and hydration or injection codes (96360, 96374) under CPT’s infusion hierarchy, with accurate start and stop time documentation.
Treatment planning, simulation, IMRT, SBRT, and brachytherapy billed correctly, including global versus technical and professional component splits.
Billing for high-cost biologics and targeted agents, with proper J-codes, step-therapy documentation, and payer-specific drug policies.
Coordination of oral chemotherapy coverage, pharmacy benefit versus medical benefit routing, and copay assistance documentation.
PET, CT, and MRI staging scans, tumor marker tests, and genomic or biomarker testing billed with the right medical necessity support.
Separation of routine care costs from sponsor-funded services under Medicare’s clinical trial policy, using QV and Q1 modifiers where required.
We manage the full oncology revenue cycle: benefit verification, authorization management, charge capture, drug and infusion coding review, claim scrubbing, payment posting, denial appeals, and patient financial counseling. Your care team stays focused on the people in the infusion chair.
When a single dose of an infused drug can cost thousands of dollars, even one denied claim hurts. Common leaks include missed JW modifiers, mismatched NDC and J-code units, expired authorizations, and underpaid drug reimbursements that are never appealed. Building an in-house team with true oncology billing experience is expensive and hard to retain. Outsourcing to RCM360 gives you specialists who already know drug payment rules, replaces fixed salary and software costs with one predictable fee, and delivers reporting that shows exactly where revenue is at risk.
Whether you run a dedicated oncology platform or a general EHR, our team logs into your existing software and manages billing directly. Chemotherapy order sets, drug inventory, and treatment plans stay in your system, with no migration and no disruption to your infusion workflow.
Request a free, no-obligation audit. We’ll review your recent infusion and drug claims, flag modifier errors, unit mismatches, and denial patterns, and show you exactly where reimbursement is slipping away.
Medicare Administrative Contractor policies, state oncology parity laws, and payer drug formularies differ by region. Our team knows the local rules, so your claims follow the right guidelines wherever you practice.
When a single-dose vial is only partly used, Medicare and many commercial payers reimburse the discarded amount. We apply the JW modifier to waste and the JZ modifier when there is none, and we make sure documentation supports both.
Infusion codes follow a strict hierarchy: initial, sequential, concurrent, and push services. Wrong sequencing, missing start and stop times, or duplicate hydration charges are common triggers. We review each claim against the hierarchy before submission.
Yes. We submit and track authorizations for drugs, radiation courses, and imaging, watch expiration dates, and alert your team when a regimen change requires a new approval.
We verify benefits up front, estimate out-of-pocket costs, and help identify copay assistance and foundation programs, so patients understand their costs before treatment begins.
Let our oncology billing specialists manage drug units, authorizations, and denials, so your team can give every patient their full attention. Book your free audit and see what your practice has been missing.
