Stop Oncology Claim Denials Before They Start

Abstract
revenue cycle teams sit at the intersection of the most expensive drugs, the most aggressive prior authorization programs, and the narrowest margins in physician practice. A single denied claim is rarely just a denied claim, it is a regimen mid-cycle, a J-code with 4-5 digits of dollars attached, and a patient already in the chair. 

This session walks the denial categories that consistently dominate hematology/oncology AR, mapped to the patient treatment lifecycle they show up in: 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 see what the denial looks like, how to find it in their own data, how to overturn the ones already in the queue, and how to prevent the next wave from arriving. Every category closes with a KPI and tier thresholds: ideal, acceptable, danger, so prevention work has a measurable outcome. 

The goal is not denial management as a permanent department function. The goal is fewer denials in the queue next quarter than this one, and the data to prove it.

Learning Objectives

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

• Identify the five denial categories that dominate oncology AR across the patient treatment lifecycle and recognize the upstream breakdowns each one points to.
• Slice denial data through the lenses most relevant to each category to surface root causes rather than symptoms.
• Apply appeals 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.

06-11-2026