Oncology Billing Services
Specialized oncology & chemotherapy billing protect high-cost drug revenue, reduce denials, and speed payments so your clinicians can focus on care
Cancer care is clinically complex and operationally demanding. Between high-cost infused drugs, detailed documentation, and payer rules that change regionally, a single misfiled claim can mean tens of thousands in lost revenue. At Sirius Solutions Global, we’re oncology-native billers we know J-codes, infusion timing rules, and chemo-specific documentation minutiae. We take the billing burden off your clinical team so you can deliver excellent oncology care without revenue surprises.
Our Comprehensive Oncology Billing Services
We don’t just submit claims. We own outcomes.
1) Eligibility, benefits & prior authorization front-line defense
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Confirm coverage, medical necessity, benefit limits for high-cost agents, and secure prior authorizations before treatment starts.
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We maintain a payer-specific prior-authorization tracker so chemo isn’t delayed and claims aren’t rejected for missing auths.
2) Drug capture, J-code & NDC mapping
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Map every administered oncology drug to the correct J-code, include NDC/lot-level detail where required, and capture units properly to maximize allowable reimbursement.
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We apply JW/JZ wastage modifiers when appropriate and document vial usage so you’re not leaving drug revenue on the table.
3) Accurate chemo administration coding
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Correct use of infusion/administration codes (96413, 96415, 96417, etc.) tied to documentation templates that reflect infusion start/stop times, pump usage, and infusate details. This prevents administration denials.
4) Clinical trial billing separation
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We build workflows that tag research vs routine claims, handle Medicare coverage analyses for trials, and ensure sponsors are billed appropriately protecting practices from payer audits.
5) Denial prevention & appeals
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Root-cause denial analytics (drug-level denials, auth misses, unit mismatches), targeted workflows to fix reoccurring problems, and clinician-backed appeals for clinical necessity denials.
6) A/R management & reporting
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Weekly dashboards (clean-claim rate, denial rate by payer, A/R 30/60/90, days-to-pay, drug capture rate).
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Proactive follow-up on high-dollar denials and prioritized appeals for high-cost drug recoupment.
7) Compliance & audit readiness
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Pre-bill checks for NDC, lot number, and prior authorization; audit-ready reports for drug usage logs, medical necessity, and research documentation.
Why choose Sirius Solutions Global for oncology billing?
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Oncology-first coders: certified coders trained on infusion and oncology drug workflows.
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Clinical + billing workflows: we pair clinical staff and coders to ensure documentation backs every high-dollar claim.
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Payer rules & LCD monitoring: we monitor carrier chemo LCDs and local rules so claims conform to regional guidelines.
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Outcome focus: clear KPIs, rapid improvements, and clinician-backed appeals on complex denials.
Why oncology billing is different
Oncology billing isn’t just “medical billing with expensive drugs.” It’s a distinct specialty because:
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Drug coding and J-codes matter. Oncology clinics bill many medications with HCPCS J-codes. Those codes require precise NDC mapping, correct units, and sometimes additional documentation (NDC, lot number, reason for use). Mishandling expensive drugs creates immediate cashflow hits.
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Chemo administration is time-based and payer-sensitive. Codes like 96413 (chemo infusion, up to 1 hour) and 96415 (each additional hour) require correct pairing between administration and the specific drug billed otherwise the carrier may deny the administration code. Medicare guidance and local carrier policies spell out specific reporting rules.
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High-cost drug wastage must be reported properly. JW/JZ modifiers and wastage reporting are common sources of confusion. When a multi-dose vial is partially unused, practices can recover the unused portion but only if they follow the appropriate claim modifiers and documentation.
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Clinical trials and routine care must be separated. Billing research-related services incorrectly to commercial payers risks audits and recoupments. Oncology billing requires robust workflows to segregate routine clinical care from trial-associated charges.
Common oncology billing problems and how we fix them
Problem: Administration code denied because drug not billed or mismatched
Fix: Our system cross-checks that each administration line has a corresponding, approved drug line with matching units/NDC before submission. If the drug is billed separately (e.g., buy-and-bill vs patient assistance), our workflows catch the mismatch before the claim hits the payer.
Problem: High-cost drug denied for lack of documentation (NDC, medical necessity)
Fix: We attach required drug-level documentation (NDC, lot, infusion record), and prepare Letter of Medical Necessity packages for appeal when appropriate. Payers increasingly request supporting clinical rationale for expensive biologics we build that into the appeals process.
Problem: Drug wastage not recovered
Fix: We implement JW/JZ modifier rules and vial-tracking documentation so you recoup possible wastage payments legally and correctly. Our templates capture leftover vial amounts and link them to claims.
Problem: Research/clinical trial charges billed to commercial payers
Fix: We set up trial vs routine charge tagging, coordinate with clinical research teams, and route charges to the correct payer (sponsor vs commercial), avoiding costly audit exposure.
Typical outcomes & KPIs we deliver
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Reduced high-dollar denials (by fixing drug/administration pairing and prior-auth workflows).
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Higher drug capture rate (more accurate J-code/NDC unit reporting).
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Faster days-to-pay via prioritized appeals and daily claim follow-up.
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Clear weekly dashboards so your CFO knows where revenue is at every stage.
AI & Technology in Oncology Billing
At Sirius Solutions Global, we use AI-driven revenue cycle instruments to maximize oncology billing efficiency:
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AI Claim Scrubbing – Find mistakes before submission to help avoid rejections.
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Predictive Analytics – Finds high-risk claims and payer patterns.
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Automated Prior Authorizations – Artificial intelligence solutions expedite permissions for expensive oncology medications.
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Machine Learning for Denial Trends – Learns from payer patterns to avoid recurrent problems using machine learning for denial trends.
Our human expertise and artificial intelligence technology guarantee your oncology business obtains top reimbursement with little disruption.
Benefits of Partnering with Sirius Solutions Global
Outsourcing your oncology billing needs to Sirius Solutions Global entitles you to:
✅ Revenue Growth – With efficient billing systems, record every owed dollar.
Proven techniques to lower underpayments and claim denials are denial reduction.
✅ Denial Reduction – Proven techniques to lower underpayments and claim denials are denial reduction.
✅ Improved Cash Flow – Rapid reimbursements with thorough claims and follow-up.
✅ Compliance Assurance – Protect your oncology business from expensive audits by means of compliance assurance.
✅ Focus on Patients, Not Paperwork – Physicians and staff can spend more time on cancer care rather than paperwork.
✅ Scalable Billing Support – We meet your development whether you are a solitary oncologist or a multilocational cancer center.
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