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Stop Oncology Claim Denials Before They Start
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 Units (CEUs)
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Earn 1 PMI CEUs for attendance at this program.
Practice Management Institute grants CEUs
for its certified professionals based on
the total number of instructional hours,
with one CEU granted per hour of classroom
instruction. CEUs may be applied to annual
recertification requirements, as directed
in the certification renewal requirements
for your credential or credentials.
If you are seeking CEU credits for other
certifications or organizations, please
contact your organization for pre-approval
and credit guidelines. A certificate of
attendance will be provided.
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