Protect revenue from high-cost therapies with J-code precision, prior authorization tracking, buy-and-bill expertise, and specialized denial management.
Oncology and infusion revenue cycle management (RCM) keeps high-cost drug billing flowing from prior authorization tracking and J-code documentation through accurate claim submission, payment posting, drug cost reconciliation, and specialized denial management—so expensive chemotherapy, immunotherapy, and specialty infusion treatments are reimbursed correctly without delays or write-offs.
Oncology and infusion practices face the highest financial stakes in healthcare: expensive therapies requiring prior authorization, complex J-code billing for chemotherapy and immunotherapy drugs, buy-and-bill inventory management, and multi-step treatment protocols that create unique documentation and coding challenges. Denial rates run 18-20% higher than primary care due to payer scrutiny on high-cost treatments. IntegraRCM protects your revenue with specialized oncology coding expertise, prior authorization tracking systems, drug cost reconciliation, and precision denial management—ensuring every dollar of treatment value is captured and reimbursed.
The stakes are clear: one denied chemotherapy claim can represent $50,000+ in lost revenue. Precision at every step—from PA tracking to J-code accuracy to denial appeals—is non-negotiable.
Oncology practices use specialized clinical and billing platforms designed for chemotherapy administration and complex treatment protocols. We adapt workflows to your system configuration, including:
Targets vary by treatment mix, payer contracts, and buy-and-bill volume. We baseline KPIs during onboarding and define SLAs to match your financial priorities.
Prior Authorization Tracking & Verification
Drug Administration & J-Code Documentation
Medical Necessity & Oncology Coding
Pre-Submission Scrubbing & Cost Validation
Payment Posting & Drug Cost Reconciliation
High-Dollar Denial Appeals & A/R Recovery
Precision authorization + accurate J-codes + cost reconciliation = protected oncology revenue.
| Operational Area | Before IntegraRCM | After IntegraRCM |
|---|---|---|
| J-code billing accuracy | Generalist coders struggle with drug units, waste documentation, and administration code pairing | Oncology-certified coders ensure >95% J-code accuracy and proper waste tracking |
| Prior authorization management | Missing or expired PAs cause treatment delays and instant claim denials | Automated PA tracking monitors status, expiration dates, and renewal requirements |
| Medical necessity denials | Insufficient clinical documentation causes high-dollar denials on expensive therapies | Comprehensive diagnosis linking and clinical evidence packages support coverage criteria |
| Buy-and-bill margin protection | Payment variances go unnoticed, eroding profits on drug inventory purchases | Drug cost reconciliation and variance detection protect margins on every claim |
| Denial recovery rate | High-dollar appeals delayed or abandoned due to complexity and resource constraints | Specialized oncology appeal templates and clinical packaging improve overturn rates |
Client: Regional oncology practice with medical oncology, radiation oncology, and infusion services serving 800+ active patients
Deployed team trained in chemotherapy protocols, J-code requirements, and waste documentation standards.
Integrated system with the practice's oncology EMR to monitor PA status and expiration dates.
Implemented rules specific to high-cost drugs, including NDC validation and medical necessity documentation checks.
Established process comparing expected reimbursement to actual acquisition costs for buy-and-bill margin protection.
Created oncology-specific appeal templates and clinical evidence packages for medical necessity challenges.
Note: Results vary by treatment mix, payer contracts, and buy-and-bill volume. We define KPIs during onboarding and report against SLAs.
| Model | Description | Best For |
|---|---|---|
| Performance-Based (% of Collections) | Fee based on monthly collections (typically 5-9% for oncology complexity), aligning incentives for maximum recovery | Community oncology practices, infusion centers with variable patient volumes |
| Dedicated Oncology Team / FTE Model | Specialized team of oncology-certified coders and billers dedicated to your practice workflows | Multi-site oncology groups, hospital-based cancer centers with high treatment volumes |
| Hybrid Support + PA Management | Base retainer for core RCM services + PA tracking/coordination as separate service line | Practices managing high PA volumes or complex payer authorization requirements |
Each engagement begins with onboarding: baseline KPI audit (denial rate by category, J-code accuracy, PA compliance, drug cost variance), workflow mapping, system integration, and SLA definition aligned to your financial goals.
Most oncology practices see measurable improvement within 60-90 days as J-code accuracy increases and PA tracking systems mature, with sustained denial rate reduction as appeal processes and clinical documentation workflows optimize.
Oncology and Infusion revenue cycle management (RCM) is the specialized process of managing high-cost drug billing, J-code accuracy, prior authorization tracking, buy-and-bill workflows, charge capture for multi-step treatments, claim submission, payment posting, denial management, and A/R follow-up for chemotherapy, immunotherapy, and specialty infusion services.
Oncology practices face 18-20% higher denial rates compared to primary care due to complex prior authorization requirements, expensive drug costs requiring pre-approval, multi-step treatment protocols, J-code billing complexity, medical necessity documentation requirements, and intense payer scrutiny on high-cost therapies. Specialized coding expertise and PA tracking systems are essential to manage these challenges.
Yes. We align workflows to Epic Beacon, Cerner PowerChart Oncology, Elekta MOSAIQ, Varian Aria, Flatiron Health OncoEMR, and other oncology practice management platforms—adapting to your drug administration workflows, J-code libraries, treatment planning systems, and infusion billing requirements.
Our automated PA tracking system integrates with your oncology EMR to monitor authorization status, expiration dates, and renewal requirements. We flag pending PAs before scheduled treatments, coordinate with payers for approvals, and prevent claims submission without valid authorizations—eliminating costly denial scenarios on high-dollar therapies.
Buy-and-bill reconciliation compares actual drug acquisition costs to reimbursement received, identifying payment variances that erode practice margins. Many oncology practices purchase expensive drugs upfront (often $10,000-$100,000+ per treatment) and rely on accurate reimbursement to maintain cash flow. Our reconciliation process detects underpayments, incorrect fee schedules, and contract variances—protecting your buy-and-bill profitability.
Most oncology practices see measurable improvement within 60-90 days. J-code accuracy improvements show impact immediately in first-pass acceptance rates. PA tracking systems reduce authorization-related denials within the first billing cycle. Medical necessity appeal processes and clinical documentation optimization compound over subsequent months, driving sustained denial rate reduction.
We'll review a sample of high-cost drug claims, evaluate J-code accuracy, assess prior authorization compliance, measure drug cost variances, identify denial patterns, and provide a revenue protection baseline with recommendations for coding excellence, PA tracking, buy-and-bill optimization, and denial prevention.
Assessment reports are typically delivered within 10 business days.