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 eating 60–70% of revenue, tiny percentage errors on massive claims translate into enormous dollar losses — and most of them never show up as a denial.
Across the 31 oncology revenue cycles we've analyzed, an average of 5–9% of gross revenue is withheld this way. On a $25M practice, that's $1.25M–$2.25M a year — and it compounds over 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 the most complex in healthcare — ASP-based drug pricing, J-codes and NDCs, infusion hierarchies, and radiology code sets that interact in intricate 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 routinely pay the primary drug line but zero or deny the JW line for "missing documentation" — even when it's charted.
Infusion hierarchy error
One oncology session can include chemotherapy administration (96413+), therapeutic infusions (96365+), hydration (96360), and IV push — billed by a strict hierarchy that sets 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 — radiation planning and treatment (e.g., 77280–77285) — reimburses well above 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 a stale ASP quarter — or an ASP+3% spread instead of +6% — you're underpaid on every unit.
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 a claim was paid, not that it matched the contracted ASP+6% or fee-schedule rate — a line-by-line check that's impossible by hand at oncology volume.
No underpayment workflow
Practices have denial and appeal workflows, but none for underpayments — a claim paid short is closed in the system and never looked at 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. No EHR change, no disruption — human review of the chart and the ASP, where payer rules just apply whatever rate is loaded.
ClearView operational visibility
Our ClearView dashboard gives leadership real-time visibility — flagging when a drug paid at $8,200 against an ASP+6% expectation of $9,800, or a same-day E/M that was 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 a documentation-backed appeal — the exact clinical and ASP detail that supports the correct payment.
Payer pattern mapping
We track which payers apply stale ASP or truncate your infusion units, and pursue systematic corrections and contract fixes — not just one claim at a time.
The 2026 OneMed Oncology Revenue Leak Index.
This isn't projection — it's 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 $7.62M, here's where it had been hiding. The costliest drugs and radiation services get underpaid the most — the leak is the baseline, 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.