Is Your Outsourced RCM Partner Failing You? Key Metrics in a Best Oncology Billing Companies Evaluation
A best oncology billing companies evaluation is critical for any practice outsourcing its revenue cycle management (RCM). Outsourcing can reduce denials and improve collections, but not every RCM vendor delivers consistent results. Without a structured evaluation, oncology practices risk working with a partner that fails to protect margins or delays revenue flow.
By focusing on measurable outcomes like accounts receivable (AR), denial rates, and appeals management, practices can quickly distinguish high-performing billing partners from those that underperform.
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Why a Best Oncology Billing Companies Evaluation Matters
Oncology billing is uniquely complex. High-cost infusion drugs, payer-specific prior authorizations, and evolving compliance rules create opportunities for costly errors. Choosing the right RCM partner isn’t just a financial decision—it directly impacts patient access and practice sustainability.
Conducting a best oncology billing companies evaluation helps practices:
Spot vendors with consistent AR reduction performance.
Measure denial prevention and appeal success.
Confirm payer compliance with oncology-specific rules.
Identify gaps in transparency and reporting.
For oncology groups looking to safeguard revenue, outsourcing to specialized oncology billing services ensures better accuracy and claim follow-up.
Key Metrics for Oncology Billing Success
When applying a best oncology billing companies evaluation, practices should look beyond surface-level numbers and assess how these KPIs impact real-world revenue.
1. Accounts Receivable (AR) Days
Target: Less than 35 days in AR.
Red Flag: If more than 20% of AR is over 90 days, collections are at risk.
💡 Context: In oncology, where infusion drugs and treatments can cost tens of thousands of dollars, every day in AR ties up vital cash flow. If a practice runs at 50+ days in AR, that could represent millions of dollars stuck in payer pipelines. A strong RCM partner must escalate unresolved claims before they fall into 90+ day buckets.
2. First-Pass Claim Denial Rate
Target: Below 5–7%.
Red Flag: High denials indicate poor eligibility checks, coding, or authorization workflows.
💡 Context: Oncology claims are vulnerable to authorization errors and drug coding mistakes. High first-pass denials show that the billing partner is not performing front-end edits or eligibility verification well. Best oncology billing companies deploy oncology-trained coders and automated edits to reduce denials.
3. Appeals Turnaround Time
Target: 7–10 business days.
Red Flag: Appeals that linger for weeks risk missing payer deadlines.
💡 Context: Payers often allow only 30–60 days for appeals. A slow RCM partner risks permanent revenue loss. Oncology practices, where denials often involve high-cost drugs, cannot afford such delays.
4. Appeal Success Rate
Target: Above 70%.
Red Flag: Low success rates suggest weak documentation or payer follow-up.
💡 Context: Many oncology denials are administrative, not clinical. An effective RCM partner includes compendia references, detailed clinical notes, and payer-specific forms to secure payment. Oncology practices should expect higher-than-average success rates when the denial cause is avoidable.
5. Net Collection Rate (NCR)
Target: 95% or higher.
Red Flag: Anything below 90% indicates lost revenue.
💡 Context: NCR measures how much collectible revenue is actually received. Oncology practices often see underpayments for infusion codes or improper bundling. The right RCM vendor actively audits remittances and pursues corrected claims.
📌 As the Healthcare Financial Management Association (HFMA) highlights, these KPIs are benchmarks that determine whether an outsourced vendor is truly protecting oncology revenue. To learn more about the benefits of outsourcing oncology billing, check out this guide on outsourcing oncology medical billing services.
Vendor Evaluation Checklist for Oncology RCM
When comparing oncology billing companies, demand transparency in these areas:
AR Monitoring: Days in AR, % over 90 days, unresolved balances.
Denial Management: Initial denial rate, average appeal processing time, success rate.
Technology: Integration with EHR, denial tracking tools, reporting dashboards.
Oncology Expertise: Prior experience with infusion billing, JW modifiers, radiation services.
Compliance: Familiarity with CMS oncology coding rules and payer updates.
Regular reviews, such as oncology medical billing audits, can uncover overlooked billing gaps and ensure the RCM partner is performing at the required level.
The AAPC also offers oncology-specific coding resources that help practices evaluate whether vendors maintain compliance with evolving billing rules.
Signs Your RCM Partner May Be Failing
Even with reports, some warning signs are clear:
Persistent AR over 45 days.
Rising denial trends for oncology drugs.
Appeals pending for months without updates.
Limited reporting transparency.
Declining collections despite steady patient volume.
Case studies like preventing oncology denials through smarter coding show that practices can turn performance around when the right billing partner is in place.
Conclusion
Outsourcing RCM can improve oncology billing performance—but only if the partner is evaluated against the right benchmarks. A structured best oncology billing companies evaluation allows practices to measure AR, denials, and appeal outcomes with precision.
For more strategies, see EHR systems for chemotherapy management or explore insights from the National Association of Healthcare Revenue Integrity (NAHRI) on revenue protection and compliance.
FAQs About Best Oncology Billing Companies Evaluation
• Accounts Receivable (AR) Days – ideally <35 days.
• First-Pass Denial Rate – below 5–7%.
• Appeal Turnaround Time – within 7–10 days.
• Appeal Success Rate – 70% or higher.
• Net Collection Rate (NCR) – at least 95%.
Request for Information
📌 Looking to evaluate your billing partner? Contact us today to learn how our oncology RCM expertise can improve AR, reduce denials, and strengthen appeal outcomes. Fill out the form below or reach out directly to discuss your needs.
