Oncology Medical Billing: A Guide and Best Practices

Oncology Medical Billing
Oncology medical billing holds key significance for hospitals and clinics as it oversees one of the most common global medical problems: cancer. It handles all of your cancer procedures and treatments with a set workflow of steps and a combination of various practices.

This blog will provide a comprehensive guide about medical billing for oncology services by covering the major steps involved in it. We will also discuss a list of practices that can be implemented to optimize this process and increase your revenue flow.

What Is Oncology Medical Billing?

oncology medical billing process

Oncology medical billing is a process implemented by healthcare providers in which they generate medical bills for their cancer treatment services. These services are availed by patients who are later billed by submitting reimbursement claims to their insurance providers.

In this way, you can receive the applicable reimbursements for your oncology services such as chemotherapy, diagnostic tests and radiation therapy. You must be well-versed with the relevant medical terminologies and oncology billing codes to implement effective medical billing.

A Step-By-Step Guide to Oncology Medical Billing

oncology medical billing problems
Oncology medical billing is usually implemented in the form of a workflow by healthcare providers. You can make your medical billing more efficient by following this workflow and executing its steps.

It comprises a wide range of important steps like verifying insurance eligibility, capturing medical charges and submitting reimbursement claims. We will also be looking at receiving reimbursements and reporting the relevant data and analytics.

    1. Verifying Insurance Eligibility

The first process in oncology medical billing is insurance eligibility verification which verifies whether your patients are eligible to avail of your oncology services. The eligibility can be verified in terms of their insurance coverage through a pre-authorization check.

This check authenticates the insurance documents and financial status of your patients and confirms the eligibility of their health plan. In this way, you can execute this step to ensure whether you should provide your cancer treatments and procedures or not.

    2. Capturing Medical Charges

After verification, you can capture the medical charges of your oncology services that have to be provided to eligible patients. This step involves documenting those services by assigning the relevant CPT and ICD codes to them.

You also have to record accurate charges for each service as they will be needed later while generating medical bills. Healthcare providers must ensure that they timely capture the charges of their oncology services as overdue payments can cause revenue loss.

    3. Submitting Reimbursement Claims

Capturing charges is followed by submitting reimbursement claims in which you have to generate medical bills and submit reimbursement claims. The bills include information about the cancer treatments availed by your patients primarily details about their procedures and charges.

You have to use those bills to submit their reimbursement claims to the insurers of your patients. Healthcare providers must ensure that their claims are complete with accurate details about the pending dues of their patients.

Prompt submission of reimbursement claims enables you to prevent delays and swiftly appeal any claim denials from the insurance companies. In this way, you can ensure that the costs of your oncology services are quickly reimbursed.

    4. Receiving Payments

This step signals nearing the completion of your oncology medical billing services. At this stage, the work is completed on your end and you have to wait for insurance providers to approve your reimbursement claims.

You are likely to receive the pending compensation for your cancer treatments if your claims are complete. On the other side, your claims may also be denied by the insurers for several reasons. An ideal scenario for you is the approval of your claims without any denials or appeals.

You can maximize them by accurately maintaining your financial records and monitoring other expenses. This enables you to stay updated on any changes in reimbursement claims so that you can effortlessly receive your healthcare payments.

    5. Reporting and Analytics

The final step in oncology medical billing is reporting and analytics. It is an optional one and involves the usage of the details recorded from a particular oncology process. You can analyze those details by tracking your revenue and accounts receivable.

Your analysis can enable you to gain informational insights and identify areas of improvement within your oncology medical billing. In this way, you can modify your current billing practices into an optimized version that delivers better financial results for your healthcare organization.

Best Practices of Oncology Medical Billing

oncology medical billing practices
There are numerous practices that can be implemented to optimize oncology medical billing. The best ones are even capable enough to transform your billing process and maximize the revenue flow.

You can also implement certain practices that comprise enhancing medical coding and ensuring accurate documentation. Other practices include using medical technology, hiring third-party services, implementing automated software and many more.

    1. Enhancing Medical Coding

You can organize training seminars and reading sessions for industry publications and collaborations with major providers. Such projects provide vital opportunities for your medical coders to enhance their medical coding skills and knowledge.

There are also technical certification programs offered by major providers like the American Academy of Professional Coders. Their programs are popular in the healthcare sector for increasing the coding accuracy of their participants.

There are ample online resources as well where your billers can find high-quality information about coding updates and guidelines. These resources enable them to stay updated and ensure that their billing practices align with the financial success of your healthcare organization.

    2. Ensuring Accurate Documentation

Healthcare providers can also optimize their medical oncology billing by ensuring that their reimbursement and billing documents are accurate and complete. This practice prevents delays in the reimbursement process and reduces the likelihood of the insurers denying your claims.

You can set up an electronic health record system to accurately record complete cancer records of your patients. These records can involve procedures like chemotherapy and radiology along with the appropriate treatment plans and diagnoses.

In addition, medical practitioners should monitor the medical codes assigned to their cancer procedures. In this way, they can include accurate details about those codes in their reimbursement claims. These methods can lead to instant reimbursements for their hospitals.

    3. Automated Oncology Software

You can also implement automated software to bill your oncology services. The prevalent oncology billing software in the medical sector primarily includes oncology practice management platforms that work wholly between healthcare providers and patients.

These platforms utilize cloud-based technologies to automate your workflow invoicing and minimize manual errors. In this way, you can prioritize patient care instead of the repetitive tasks performed by automated software.

Most of these software have a user-friendly and intuitive interface that comes with customizable dashboards. You can work on these dashboards to monitor your healthcare metrics like pending medical bills and overdue reimbursement claims.

    4. Using Medical Technology

Various aspects of medical technology can be used to efficiently access and manage patient information. They enable healthcare providers to effectively verify the insurance coverage of their patients and accordingly submit reimbursement claims.

In this way, they save a lot of time for you to focus on other important tasks like taking care of your patients. Medical technology also integrates digital solutions into capturing medical charges which minimizes the involvement of incorrect and missed charges.

In addition, you can also get real-time access to the coding and billing information of your oncology services. It can be later shared with your patients to mainstream the relevant medical guidelines and maximize revenue cycle management.

    5. Hiring Third-Party Medical Services

Furthermore, you can ease the challenges of your medical oncology billing services by hiring third-party services. They can especially be beneficial for you if you have a small-scale hospital or clinic with limited resources.

In this case, you can outsource the medical billing operations for your oncology treatments and procedures. By doing this, medical practitioners ensure that their operations are being handled by expert and professional oncology billers.

You can trust them to skillfully follow the oncology billing guidelines and standards set in the healthcare sector. Third-party services can also easily handle your medical billing and execute important steps like submitting reimbursement claims and following up on them.

The Bottom Line


This blog explored the process of oncology medical billing and examined its role in the successful functioning of healthcare organizations. There are primarily five steps and best practices involved in its holistic implementation for advanced cancer treatments.

Health Quest Billing has an experienced team of oncology medical billers assigned specifically to manage the billing tasks of your oncology procedures. Contact us today and learn more about the medical services we have in store for your cancer-related issues.

Frequently Asked Questions (FAQs)

    1. What is oncology coding?

Oncology coding refers to a complex process in which medical coders have to assign specific codes to oncology services. These services primarily include cancer diagnoses and procedures like radiation, infusions and chemotherapy.

    2. What is the code for oncology infusion?

The code for oncology infusion is 96417 which is assigned to chemotherapy administration using the intravenous infusion technique. Another code for intravenous infusion is 96365 which is assigned to prophylaxis and diagnosis-related services.

    3. What is the ICD classification of oncology?

The ICD classification of oncology is an extension of the International Statistical Classification of Diseases and Related Health Problems. It classifies oncology services based on their domains and primarily targets tumor diseases.

    4. What are the three types of oncology?

The three types of oncology are radiation, medical and surgical. These are considered three different types as they have different modes of treatment.

    5. What is IV oncology?

IV oncology is termed intravenous chemotherapy and is primarily administered to treat and kill cancer cells. It is administered with an IV inserted in a large vein mostly through the hand or the arm.

    6. What advantages do medical billing companies offer for the oncology billing process?

Medical billing companies specialize in the oncology billing process, bringing together billing experts with years of experience in oncology billing. Their comprehensive knowledge ensures accurate coding, faster payment, and prevention of revenue leakage, ensuring a smooth billing process for cancer centers.

    7. How can a medical billing company help in avoiding loss of revenue for oncology practices?

A medical billing company, with its team of billing specialists, ensures that medical claims are accurately coded and promptly submitted, reducing unpaid claims and claim rejections. Their expertise in the intricate coding process and experience with comprehensive treatment plans for cancer patients ensures minimal errors and maximized revenue for oncology practices.

    8. Why is payment posting essential in the medical billing process for oncology?

Payment posting in the medical billing process is vital as it records incoming payments against the specific services rendered. This step ensures that the oncology revenue cycle management stays organized, preventing revenue leakage and helping in faster reconciliation of accounts.

    9. How do coding services impact the revenue for oncology practices?

Coding services, when executed by a Coding Specialist with experience in the complex coding of oncology treatments, ensure precise coding of treatment procedures. Accurate coding is pivotal as coding errors can lead to claim rejections, causing a delay in payments and potential loss of revenue.

    10. How can medical billing software benefit a medical practice specializing in oncology?

Medical billing software streamlines the billing process, automates tasks, and minimizes manual errors. For oncology practices, it ensures a smooth billing process, from capturing charges related to chemotherapy treatment to submitting claims, thereby expediting the payment phase and enhancing revenue cycle management.

    11. Why should cancer centers consider partnering with a billing partner specializing in oncology?

Partnering with a billing partner that has a specific focus on oncology ensures that the medical billing professionals handling the accounts have in-depth knowledge of chemotherapy treatment phases and oncology-specific challenges. Such specialization helps in accurate claim submissions, reduces unpaid claims, and ensures a smooth revenue flow for the cancer center.

    12 How do billing specialists help in managing the treatment procedures for cancer patients?

Billing specialists, with their experience in oncology billing, understand the comprehensive treatment plans for cancer patients. Their expertise ensures that every treatment phase, from diagnosis to treatment procedures, is accurately documented and billed, ensuring that medical claims are paid promptly and reducing the chances of revenue leakage.