Oncology RCM Staffing Challenges
How Staffing Instability Disrupts the Oncology Revenue Cycle
1. Eligibility, Benefits, and Financial Clearance Bottlenecks
In oncology, challenges with pre-authorization and eligibility/benefits verification/analysis don’t just inconvenience patients — they can delay life-saving treatment and jeopardize practice revenue.
- Practices with minimal front-end staff often rely on limited staff to verify benefits, secure prior auth, and coordinate financial assistance.
- Without redundancy, a single absence can result in missed authorizations, patient financial confusion, and/or billing delays.
Fedora’s Advantage: Our services include dedicated, oncology-specific staff that handle eligibility checks, benefit investigation, and full pre-authorization services — all optimized for oncology’s unique demands.
2. Coding Complexity and Constant Change
With a continuous pipeline of new immunotherapies, targeted agents, genetic tests, and bundled services, oncology coding is never static.
- Community practices often can’t dedicate time or resources to stay current on ICD/CPT changes, CMS rule updates, or payer-specific requirements.
- Burned-out or overextended coders are more likely to default to safer codes, potentially underbilling high-value services.
Fedora’s Advantage: Our coding team is 100% oncology-focused and proactively trained on:
- EOM, MIPS, and clinical trial documentation
- Drug wastage coding (JW modifier)
- NDC-to-J-code mapping for all major payers
3. When Teams are Stressed Denials Can Happen — But They Shouldn’t Define Your Workflow
Yes, denials are rising — and yes, they matter. But denials are a symptom, not a root cause. Staffing stress leads to:
- Missed documentation
- Overlooked payer updates
- Inconsistent prior auth processes
- Unfiled or expired appeals
Many practices simply don’t have the capacity to track trends, perform root-cause analysis, or recover lost revenue.
Fedora’s Advantage: We embed denial prevention upstream through better coding, documentation, and claims validation. Our services include expert denial avoidance and resolution teams, who know how to:
- Appeal complex medical necessity issues
- Escalate with payers strategically
- Recover underpayments and misclassified denials
4. Back-End Workflow Fragmentation
Many oncology practices struggle to keep billing and collections running smoothly when:
- Posting staff are overwhelmed or inexperienced with ERA/EOB logic
- Patients are confused about balances due to accumulators or changes in copay assistance rules
- Payments from multiple sources (payer, patient, foundation, manufacturer) require manual reconciliation
Fedora’s Advantage: Our back-end specialists ensure:
- Accurate and timely posting
- Foundation and patient assistance application matching
- The ability to properly manage complex research billing processes
- Clean monthly AR aging and recovery strategies
5. Reporting, Forecasting & Compliance Visibility
Overstretched practices often rely on reactive reporting, making it hard to:
- Understand true AR aging trends
- Forecast cash flow based on payer mix
- Prepare for regulatory changes (e.g., EOM reporting, OIG guidance)
Fedora’s Advantage: We provide:
- Custom reporting dashboards tailored to oncology
- Regular revenue cycle health checkups
Proactive alerts around payer and regulatory changes
🧠 Summary: Revenue Integrity Requires Workforce Strategy
The oncology revenue cycle is a living system — and when one part breaks (staffing, training, process), the entire system suffers. For community practices, the stakes are even higher: every missed charge or claim delay could mean a hit to cash flow, patient satisfaction, or even access to care.
| RCM Function | Risk if Understaffed | Fedora’s Solution |
| Front-end Processes | Missed auths, treatment delays | Deeply experienced, oncology-specific EV/BV and Pre-Auth teams |
| Coding | Underbilling or payer audits | Certified coders specializing in oncology |
| Billing | Claim lag, data errors | A combination of highly capable team members & proprietary technology |
| Denials | Lost revenue, poor trends | Proactive prevention + expert appeals |
| Trials Billing | Mis-billed claims, lack of trial reimbursement | Team members that manage trials billing in some of the most sophisticated oncology groups in the US |
| Reporting | Poor decision-making | Deeply insightful and customized analytics + strategic insights |
Reach out to us to learn more about how Fedora can help your oncology practice thrive at contactus@ifedora.com.