Oncology Medical Billing & Credentialing Services

Advanced Financial & Compliance Support for Oncology Clinics, Infusion Centers & Hospital-Based Cancer Care Providers

Why Oncology Demands Specialized Billing Expertise

Oncology billing is complex and highly regulated. Between chemotherapy regimens, immunotherapy, radiation sessions, supportive care medications, and diagnostics, a single error—such as an incorrect modifier or missing prior authorization—can result in thousands of dollars of revenue loss or claims denial.

Oncology is also one of the most frequently audited medical specialties due to high-value drug billing and rapid treatment innovations. At Oakview Medical Billing Solutions, our oncology billing and credentialing experts ensure accurate coding, streamlined credentialing, and robust audit protection.

Common Challenges We Solve

Complex Chemotherapy & Infusion Coding
- Proper use of HCPCS J-codes to bill antineoplastics, biologics, and supportive medications
- Accurate pairing with infused service codes (e.g., 96412, 96365) and adherence to payer-specific NDC billing rules
Prior Authorization & Drug Coverage Verification
- Each high-cost oncology drug often requires prior approval. Our team verifies coverage, submits authorization requests, and tracks approvals to prevent reimbursement delay.
Split Claims & Payer Sequence Management
- Billing hospital outpatient charges separately from professional provider codes to prevent duplication and ensure correct billing hierarchy.
Documentation for Medical Necessity
- Ensuring each claim is backed by clear treatment plans, diagnostic history, pathology, and supporting symptom documentation.
Modifier Accuracy & Denial Prevention
- Correct application of modifiers like JW, JZ, 59, 78, 79, or 25 to prevent bundling rejections and enable separate billing where applicable.
Managing Global Treatment Episodes
- Correctly billing for services during chemotherapy cycles and post-therapy care without risking overlap or inappropriate global fee downgrades.
Coordination Between Specialists
- Oncology billing often involves collaboration between oncologists, pharmacists, infusion nurses, and oncology social workers. Our workflows support multidisciplinary coordination.

What Oakview Provides for Oncology Practices

Milestone-Based Credentialing

Fast-track onboarding through Medicare, Medicaid, PPO networks, and infusion payers
CAQH management and DEA/state license verification
NPI setup and taxonomy classification (e.g., Oncology, Hematology)
Credentialing for advanced practice providers including NPs, PAs, and oncology-trained social workers

Infusion & Drug Claim Processing

ICD-10 and CPT auditing to ensure drug and disease correlation
Clean claim preparation including drug dosage verification, unit rationale, and billing modifiers
Automated injection and infusion tracking tools integrated with EHR/billing platforms

Denial & Appeals Management

Root cause evaluations for recurring denial types (e.g., medical necessity, PA requirements)
Appeals support with physician-written documentation, chart notes, and payer-specific references
Escalation protocols to reduce aged AR days

Revenue Monitoring & Financial Reporting

Clean claim rates, denial reasons, and payer remittance trend tracking
Net collection analysis and benchmarking via dashboards
Key performance indicators monitored: AR days, denial ratio, clean claim %, payer mix percentages

Key CPT & HCPCS Codes for Oncology

Real Results from Oncology Practices

20% increase in monthly collections post onboarding
~30% faster reimbursement turnaround due to clean coding and verified eligibility
Reduction of paid denials by over 50% within the first two months
Accelerated credentialing timelines: average submission to paneling in <30 days

Who We Support in Oncology

Community and hospital-based oncology groups
Infusion-only independent centers
Radiation oncology and surgical oncology practices
Pediatric and adult oncology clinics
Pharmacist-led biologic infusion centers
Comprehensive cancer care systems

Why Choose Oakview for Oncology Revenue Support

Oncology-specific coders and credentialing staff
HIPAA-compliant billing platforms with multi-provider tracking
Award-winning support for both solo and large multi-site operations
Data-driven recommendations for clinical and financial improvements
U.S.-based support teams for immediate communication and custom workflows

Ready to Build a Future-Ready Oncology Practice?

Let us partner with your team to lift administrative burdens and transform your revenue cycle from reactive to strategic. Oakview delivers credibility, accountability, and consistent financial performance—while you focus entirely on patient care.