Stop Oncology Claim Denials Before They Start

This session covers the denial categories that dominate hematology/oncology accounts receivable: coverage and eligibility at the start of a regimen, prior authorization mismatch, J-code unit and waste documentation, infusion administration hierarchy, and site-of-service downgrades. 

For each category, attendees will learn about specific denials, how to identify them in their own data, how to overturn those already in the queue, and how to prevent the next wave from arriving. The program closes with the KPIs and tier thresholds needed to maintain oversight,  set accountability, and measure progress.

Learning Objectives

By the end of this program, participants will be able to:

• Identify the denial categories that dominate oncology accounts receivable across the patient treatment lifecycle and recognize the upstream breakdowns
• Understand denial data most relevant to each of the 5 denial categories
• Apply appeal strategies matched to denial type, including coverage reconciliation, prior authorization scope corrections, J-code waste documentation, and infusion administration coding adjustments
• Design prevention workflows to stop high-frequency denials before claim submission

• Measure prevention performance using category-specific KPIs with a defined response plan when metrics move out of range

Continuing Education:
1 PMI CEU(s)