Specialty billing
Hematology and Oncology Billing Where Every Unit Counts
Infusion hierarchy, high-cost drug claims and wastage documentation where a single error is worth thousands.
The challenge
What makes hematology billing different
Hematology and oncology carry the highest per-claim financial exposure in outpatient medicine. A single infusion encounter can involve a drug costing more than a month of a primary care practice collections, and the difference between a paid claim and a denied one often comes down to unit calculation or a wastage modifier.
The administration coding is equally unforgiving. Infusion services follow a strict hierarchy of initial, sequential and concurrent services, and sequencing them incorrectly on a multi-drug day reduces payment on work that was fully delivered and fully documented.
Why us
Why hematology and oncology practices work with us
Specialty billing is not a marketing label for us. Coders and A/R staff are assigned by specialty, so the person on your account reads notes like yours every day.
Get a free assessment- Drug units calculated against the billing unit definition, not the vial size
- Wastage documented and modified correctly rather than silently absorbed
- Infusion hierarchy applied correctly on multi-drug and multi-hour days
- Prior authorization obtained before the drug is ordered, not after it is given
Scope of work
What we handle for hematology practices
The work below is specific to this specialty, not a generic billing checklist with the name swapped out.
Drug and biologic claims
HCPCS drug coding with unit calculations checked against the billing unit rather than the vial.
Infusion administration hierarchy
Initial, sequential, concurrent and hydration services sequenced correctly for the documented times.
Wastage documentation
Discarded drug billed with the correct modifier and the documentation an audit will require.
Prior authorization management
Regimen-level authorization secured before administration, and tracked across cycle changes.
Buy-and-bill reconciliation
Acquisition cost reconciled against reimbursement so margin erosion is visible immediately.
Treatment plan alignment
Claims checked against the documented regimen so cycle changes do not create orphan charges.
The Right Way difference
What we watch on hematology claims
These are the details that separate a paid claim from an appealed one in hematology. They are checked on every claim, not sampled.
- 01 Billing unit definitions, which frequently differ from the vial or package size the practice purchases
- 02 Wastage modifier requirements, now mandatory reporting for single-dose containers on many drugs
- 03 Start and stop times in the infusion record, which determine the administration codes entirely
- 04 Authorization validity across a treatment cycle, including regimen or dose changes mid-course
- 05 Payer-specific site-of-care policies that can redirect where a drug may be administered
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Years running revenue cycles for physician practices
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Providers billed for across every specialty we serve
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First-pass clean claim rate
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Median days in accounts receivable
Questions
Hematology billing questions
What practices in this specialty ask us most often before making a change.
Ask us something elseEvery drug claim is checked against the HCPCS billing unit definition rather than the package size, and high-value claims get a second review before release. On this specialty the cost of a second look is trivial next to the cost of a mis-keyed unit.
Yes. Discarded drug from a single-dose container is billable when documented properly, and reporting requirements have tightened. Practices that absorb wastage rather than bill it are giving away real money on every partial vial.
We do. Authorization is secured at regimen level before administration and re-checked whenever the regimen or dose changes, because an authorization that no longer matches the treatment given will not survive review.
How it works
Getting started takes about a month
The same four steps whichever specialty you are in. No system migration and no gap in your cash flow.
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01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
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02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
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03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
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04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Let us look at your hematology claims
Send us a sample and we will tell you specifically what is being coded, denied or under-paid — and what it is worth to fix. Free, and yours to keep.