SpecialtiesMedical specialties
How we see oncology billing.
Reviewed by the VisMed medical specialties billing team
A community oncology practice buys drugs, administers them and bills for both. The drug lines dwarf everything else on the ledger, and they are billed by units that rarely match vial sizes, with wastage rules, NDC reporting, sequencing requirements and per-regimen authorization. The administration codes follow a hierarchy of initial, sequential and concurrent services that has to be built from the infusion record.
Any error on a drug line is an error measured in thousands. Any authorization gap is a dose the practice has paid for and will not be paid for. And payers audit oncology more closely than most specialties, so overbilling is as dangerous as underbilling.
VisMed’s oncology coders construct administration claims from the nursing record rather than a charge sheet, our drug desk authorizes per regimen and reconciles units to inventory, and we report each plan’s allowed rates against your acquisition cost drug by drug.
Where oncology practices lose money
The patterns we find in the aging and denial history before anything else changes.
Administration hierarchy built wrong
One initial service per encounter, then sequential and concurrent codes, hydration rules and push-versus-infusion by time. Built from memory instead of the record, it is short or wrong.Units, wastage and NDC
Drug units per billing unit, wastage with its modifier and documentation, and NDC in the required format. A single error denies a high-dollar line.Regimen changes without re-authorization
A dose change, a new agent or a cycle count beyond the approval needs a new authorization. Continued treatment on the old approval is not paid.Supportive drugs and growth factors
Antiemetics, growth factors and iron have their own authorization and frequency rules, and are commonly given outside them.Treatment planning, counseling and care management unbilled
Long decision-making visits, advance care planning and care-management time are supported by the codes and rarely captured.
What we do differently for oncology
Specialty-matched coders and a denials specialist, working inside your own system.
We build claims from the infusion record
Our coders construct administration claims from start and stop times and the drug sequence in the nursing record, not from a charge sheet.We track authorization per regimen
Each patient-regimen is a case with approved agents, doses and cycles. Changes trigger a new request from us before the next dose.We reconcile inventory monthly
Units billed and wastage documented are reconciled to the drug inventory, and NDC reporting is validated against the purchased product.We report rate versus cost per plan
Allowed rates for each drug on each plan are compared with acquisition, so you see the margin drug by drug.
What we bill
The procedure and code families your account team already works in.
Oncology billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed avoid errors on high-dollar drug lines?
By building each claim from the nursing infusion record rather than a charge sheet, validating units against vial sizes and inventory, applying wastage rules per payer, and checking the NDC format before the claim leaves. VisMed has a second coder review every drug line.
What happens when a regimen changes mid-treatment?
VisMed updates the case and sends a new authorization before the next dose. The approved agents, doses and cycle counts are tracked per patient so a change is never billed on the old approval.
Can VisMed show us where drugs are paid below cost?
VisMed compares allowed rates by plan and drug with your acquisition cost and reports it to you, so you can make purchasing and site-of-care decisions with the margin visible.
Does VisMed handle oral oncolytics?
The management side, yes: the visits, adherence and care-management programs, and prior authorization support for the prescriptions. The dispensing is billed by whoever dispenses.
How does VisMed handle payer audits of oncology claims?
By making the record answer the audit. Every drug line links to the infusion record, the inventory entry and the authorization, so when a payer requests documentation VisMed assembles it from the file rather than reconstructing it. The same discipline is why the lines were paid correctly in the first place.
Also in medical specialties
Cardiology
Diagnostics, device checks and cath-lab professional fees.
Endocrinology
CGM, infusion and chronic-condition management codes.
Gastroenterology
Endoscopy, ASC splits and screening-vs-diagnostic rules.
Hepatology
Infusions, specialty drugs and prior authorization.
Nephrology
Dialysis MCP, monthly capitation and transplant follow-up.
Pulmonology
PFTs, sleep crossover and DME orders.
Rheumatology
Biologic infusions, J-codes and buy-and-bill.
Neurology
EEG/EMG, infusion and long-visit E/M.
Hematology
Infusion and lab-linked visits.
Immunology & allergy
Testing panels and immunotherapy series.
Infectious disease
Inpatient rounds, long-term therapy and telehealth.
Dermatology
Lesion coding, pathology and cosmetic separation.
Pain management
Injections, ablations and strict authorization trails.
Psychiatry
Med-management with therapy add-ons, parity rules.
All specialties
The full list, in six groups
See where your oncology practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med