Oncology
Oncology Billing and Coding Solutions
Accelerate oncology revenues with AI that captures every chemotherapy, radiation, and surgical code flawlessly, auto-checks payer rules, and speeds reimbursements.
What Is Oncology Coding and Billing?
Oncology coding and billing translate complex cancer treatments into clean, payable claims by pairing detailed CPT/HCPCS and ICD-10 codes with rigorous revenue-cycle checks.
Coders assign precise ICD-10 diagnosis codes and CPT/HCPCS procedure codes, apply modifiers, and ensure accurate documentation for complex therapies.
Then, billers verify insurance eligibility, secure prior authorizations, capture all charges, and submit claims for reimbursement.
Complex Multi-Modality Coding
Oncology combines chemotherapy, immunotherapy, radiation, surgery, and supportive drugs, each governed by its own CPT/HCPCS rules and sequencing requirements.
Impact: Mis-ordering even one infusion step causes denials
High-Cost Drug Unit and Wastage Precision
Payers demand exact units, NDC numbers, and JW/JZ wastage modifiers for drugs that may cost thousands per dose.
Impact: A single unit error can trigger audits or payment holds
Clinical-Trial Billing Compliance
Trials demand that routine care be separated from research-related services using specific modifiers and condition codes.
Impact: Incorrect segregation jeopardizes reimbursement
Our Expertise in Oncology Billing & Coding
Amy: AI Medical Coder for Oncology Care
- Codes every chemotherapy, immunotherapy, radiation, and surgical service with precise CPT, HCPCS, and ICD-10 combinations
- Applies oncology-specific modifiers and validates drug units + NDCs
- Flags missing regimen details (dose, route, cycle, radiation fractions, pathology reports) to close documentation gaps
- Audits charts for bundling, MUE, and NCCN guideline compliance in high-volume infusion workflows
- Provides line-by-line rationale and evidence for each code to ensure transparency and prevent denials
Mark: AI Medical Biller for Oncology Care
- Verifies eligibility and benefit accumulators across Medicare, Medicaid, and commercial payers, including prior-auth requirements for high-cost drugs
- Confirms units, modifiers, and payer edits before claim submission to reduce oncology-specific denials
- Submits claims and posts charges directly in your billing platform
- Reads ERAs and scanned paper EOBs, posting payments, and reconciling complex outpatient drug reimbursements
- Continuously learns from oncology denial patterns (medical necessity, unit limits, wastage rules) to minimize future rejections
Adam: AI Denial Manager for Oncology Care
- Checks real-time claim status across multiple payers via portals, chatbots, and aggregators
- Makes AI-driven calls, navigating IVRs and live agents to resolve denials for chemotherapy drugs, radiation plans, and genomic tests
- Uses customizable call scripts that account for wastage documentation, therapy cycles, and clinical-trial billing rules
- Handles both outbound follow-ups and inbound queries, providing call recordings, summaries, and next-step recommendations
- Prioritizes high-value oncology claims by age, dollar amount, and payer policy to speed collections and protect margins
Common billing challenges in oncology?
Critical modifiers in oncology billing?
How does prior authorization affect oncology claims?
What are the most common oncology billing codes?
How to reduce claim denials in oncology?
What is the required documentation for oncology billing compliance?
How does AI streamline oncology billing?
Ensuring accurate ICD-10 coding in oncology?
What is the role of HCPCS codes in oncology billing?
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Email: info@combinehealth.ai
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