Home Specialities Oncology
Chemo · infusion · radiation
full oncology billing
Oncology-certified coders
chart & ASP review
All major payers
commercial, Medicare & MA
Underpayment recovery
on claims marked paid
At oncology drug costs, a 2% shortfall is a catastrophe.
Oncology runs the most financially punishing reimbursement environment in healthcare. With drug acquisition consuming 60 to 70 percent of revenue, small percentage errors on large claims create major dollar losses, and most of those losses never appear as denials.
Across the 31 oncology revenue cycles we've analyzed, an average of 5–9% of gross revenue is withheld this way. For a $25M practice, that can mean USD 1.25M to USD 2.25M per year, and the impact compounds across every payer contract cycle.
See it on your claimsWhat 5–9% looks like on a $25M practice
The 5–9% range reflects OneMed's analysis of 31 oncology revenue cycles; the dollar figures apply that range to a $25M example practice. Your actual exposure depends on payer mix, drug mix, and documentation.
Five ways oncology dollars quietly disappear.
Oncology billing is one of the most complex areas in healthcare. It includes ASP-based drug pricing, J-codes and NDCs, infusion hierarchies, and radiology code sets that interact in specific and complicated ways. These are the underpayment patterns we find most often, buried in claims you already booked as paid.
ASP reimbursement shortfall
Part B drugs reimburse at ASP + 6%, recalculated quarterly by CMS. Payers frequently apply a stale ASP quarter, the wrong methodology, or an ASP+3% "spread" — underpaying a few percent on every unit of a high-cost drug.
Drug wastage (JW / JZ) trap
Vials rarely match the prescribed dose; the discarded remainder is billable wastage with Modifier JW, and JZ signals zero waste. Payers often pay the primary drug line but zero or deny the JW line for missing documentation, even when the wastage is documented in the chart.
Infusion hierarchy error
One oncology session can include chemotherapy administration, therapeutic infusions, hydration, and IV push services. These are billed under a strict hierarchy that determines which service is primary. When it's applied to minimize payment, or an NCCI edit bundles a separately billable service into the chemo code, the higher-value service is silently reduced.
Same-day E/M downgrade
A significant, separately identifiable E/M on the same day as an infusion is billable with Modifier 25. Payers routinely deny it, or pay it but downgrade the level (e.g., 99215 → 99213), trimming $50–$150 a visit.
Diagnostic vs. therapeutic radiology
Therapeutic radiology, including radiation planning and treatment codes such as 77280 to 77285, reimburses at a different level than diagnostic imaging. Payers sometimes misclassify therapeutic services as diagnostic, paying 30–50% less, or bundle separately billable simulation imaging into the global radiation package.
Check the ASP yourself. The rates are public.
Medicare and many commercial payers reimburse Part B drugs at ASP + 6%, and CMS republishes ASP every quarter. When a payer applies an outdated ASP quarter or uses ASP plus 3 percent instead of ASP plus 6 percent, every unit is underpaid.
The rates are public and you can check them against your remits. On a drug dosed hundreds of times a month, a couple hundred dollars a unit compounds into a serious number fast.
See it on your own claimsCurrent ASP vs. a stale quarter
ASP + 6% is the published Medicare Part B rule; the $5,000 ASP is an illustrative example — confirm the current quarter's published ASP for each drug. Actual exposure depends on drug and volume.
Paid-means-paid is oncology's most expensive assumption
It isn't effort. No team can hand-verify ASP quarter-by-quarter, drug-by-drug, across a high-volume oncology book.
No ASP or contract-level verification
Most teams confirm that a claim was paid, not that it matched the contracted ASP plus 6 percent or fee-schedule rate. At oncology volume, that kind of line-by-line manual review is not realistic.
No underpayment workflow
Practices usually have denial and appeal workflows, but not underpayment workflows. A claim that is paid short often closes in the system and is never reviewed again.
Timely filing runs out
Underpayment appeals have filing windows, often 90–365 days. Unspotted, the recovery opportunity is permanently lost.
We reconcile every claim to the price you should've been paid.
Oncology-certified coders inside your existing system. There is no EHR change and no disruption. We add human review of the chart and ASP details where payer systems simply apply whatever rate is loaded.
ClearView operational visibility
Our ClearView dashboard gives leadership real-time visibility. It flags when a drug pays at USD 8,200 against an ASP plus 6 percent expectation of USD 9,800, or when a same-day E/M is downcoded, without changing how your staff logs in.
Expert clinical chart audit
Flagged claims route to our oncology-certified coders, who work inside your system to read the clinical notes, verify wastage documentation, confirm infusion start and stop times, and review E/M medical necessity.
Targeted clinical appeal
We draft documentation-backed appeals with the clinical and ASP details needed to support correct payment.
Payer pattern mapping
We track which payers apply stale ASP rates or truncate infusion units, then pursue systematic corrections and contract fixes instead of treating each claim as a one-off issue.
The 2026 OneMed Oncology Revenue Leak Index.
This is not a projection. It is the pooled reality across every oncology revenue cycle we audited over 18 months.
31
oncology revenue cycles audited
156,000+
claims audited
$7.62M
recovered for clients
89.9%
recovery rate on appeals
Of that USD 7.62M, this is where the money had been hiding. The costliest drugs and radiation services are often underpaid the most. The leak is the baseline problem, not the exception.
| Underpayment pattern | Share of recovered value |
|---|---|
| ASP reimbursement shortfalls | 29% |
| Drug wastage (JW/JZ) traps | 26% |
| Infusion hierarchy errors | 21% |
| Same-day E/M downgrades | 16% |
| Diagnostic vs. therapeutic radiology | 8% |
Aggregated across OneMed oncology underpayment audits over the trailing 18 months ($8.47M identified, $7.62M recovered). Individual results vary by payer, documentation, and contract terms.