Prior Authorization: Turning a Bottleneck into a Benefit
Prior authorizations remain one of the biggest hurdles in cancer care, delaying life-saving treatments and exhausting staff resources. Our RCM solutions:
• Ensure timely and accurate prior authorizations to improve time to treatment and eliminate accidental spend.
• Take the heavy lift of these processes off of your internal staff, reducing rework and staff burnout.
• Reduce denials upfront by ensuring documentation is payer-specific and complete.
The result? Faster starts for patients, less time lost to payer back-and-forth, and more predictable cash flow.
Eligibility & Benefit Verification: Preventing Denials Before They Happen
One of the most common and avoidable revenue leaks in oncology comes from incorrect eligibility and benefit verification. With constantly shifting payer rules, this step is more critical than ever. Fedora helps practices by:
• Verifying coverage quickly and accurately, preventing costly retroactive denials.
• Clarifying out-of-pocket estimates, so patients understand their financial responsibility before they initiate treatment – allowing you to find financial assistance when appropriate and to set up payment plans.
• Catching payer-specific nuances—like step therapy or specialty carve-outs—before claims are filed.
This reduces denials, accelerates payment, and builds trust between practice and patient.
Staffing Pressures: Doing More with Less
With workforce shortages hitting every level of healthcare, community oncology practices often struggle to staff billing and authorization departments. Fedora alleviates this pressure by:
• Providing essential staff with decades of oncology experience to either manage or support your RCM operations.
• With both end-to-end and bespoke RCM offerings, Fedora’s team can support any oncology practice – from the most complex, multi-specialty and modality practice to a one provider group working to support the patients in the communities in which they live.
• We will allocate the right staff and processes to manage repetitive, manual tasks so lean teams can focus on higher-value work.
Keeping Up with Private Payer Tactics
Private payers are constantly introducing new hurdles – whether it’s restrictive prior authorization criteria, reduced reimbursement rates, or shifting drug utilization mandates. Fedora ensures practices stay ahead by:
• Monitoring payer policy changes throughout our network of practices and adapting billing strategies accordingly.
• Providing denial analytics to identify patterns and fight back against unfair practices.
• By ensuring accurate EV/BV processes and timely and complete Prior-Authorizations, your Fedora team avoids payment challenges and makes sure your AR is as low as possible across your entire payer mix.
The Critical Importance of Shortening Accounts Receivable
Perhaps the most urgent financial challenge for oncology practices today is the timing mismatch between receivables and payables. Distributors like Cardinal, Cencora, and McKesson require drug invoices to be paid quickly – often within tight windows that can slide into interest being applied to past-due amounts. The key is to mitigate slow payer reimbursements that threaten cash flow.
Fedora helps practices shorten accounts receivable (AR) timelines through:
• Proactive denial prevention to avoid reimbursement delays.
• Aggressive follow-up and appeals to move stuck claims forward.
• Revenue cycle optimization processes that accelerate cash posting and reconciliation.
When AR days are reduced, practices can reliably pay their drug bills on time, maintain distributor relationships, and ensure uninterrupted access to vital therapies for patients.
Leverage Fedora Expertise Towards Service Line Expansion
With all of the challenges to medical and radiation oncology reimbursements, many of our practices are expanding their revenue by bringing new therapies or specialties into their practices. This is an area where Fedora’s team can provide essential support as you expand your practice.
• Thinking about adding a specialty to your practice such as urology, surgery or internal medicine? We support multi-specialty practices across the U.S. who have complex specialty mixes, ensuring the smooth addition and onboarding of new providers, including their credentialing.
• The addition of new diagnostics or treatment modalities are essential elements of long-term revenue growth. From imaging, diagnostics and new line therapies like theranostics, your Fedora team will support you as you prepare for going live with new services, ensuring the associated RCM will be smooth and seamless from day one.
Building Financial Resilience in Oncology
The pressures facing community oncology aren’t going away – but with the right revenue cycle partner, practices can protect their financial health, maintain independence, and continue delivering exceptional patient care.
At Fedora Healthcare Solutions, we are committed to helping oncology practices:
• Get paid faster
• Reduce denials and write-offs
• Keep cash flow steady
• Expand your practice with confidence
• Navigate payer complexity without fail
Because when practices are financially strong, patients get timely access to the treatments they need, and community oncology thrives.
