Oncology billing and revenue cycle, 50-state coverage.

What good oncology billing execution looks like.

The operating discipline we install on every oncology billing engagement.

1. Infusion and chemotherapy administration code accuracyOncology infusion billing requires precise capture of initial, sequential, concurrent, and additional hour codes (96360-96376, 96401-96450, J-codes for drugs). your state infusion centers leak revenue on undercoded administration time.
2. J-code drug pricing and ASP+6 reimbursementOncology drugs reimburse under Medicare at Average Sales Price + 6 percent (Part B), with similar logic on many commercial. your state oncology practices need accurate J-code billing, NDC reporting, and ASP-aware revenue forecasting.
3. Prior authorization for oncology drugsSpecialty oncology drugs require payer prior authorization, often with clinical criteria tied to NCCN guideline alignment. PA automation tuned for oncology compresses access-to-treatment time and reduces denials.
4. E/M leveling for oncology visitsOncology visits qualify for higher E/M levels under MDM complexity rules. your state oncology practices that under-level E/M leave significant revenue uncollected.
5. OCM and Enhancing Oncology Model participationPractices in the CMS Enhancing Oncology Model (EOM) coordinate clinical, financial, and reporting workflows for value-based payment. your state EOM participants need RCM that flows into program reporting.
6. 340B drug pricing for eligible oncology entitiesFQHC + DSH-eligible hospital oncology practices in 340B require precise inventory tracking, contract pharmacy coordination, and proper claim modification (TB modifier).