rcm solutions Pulmonology facilities

Medical Billing And Revenue Cycle Management Solutions For Pulmonology Facilities

Pulmonologists, also known as respiratory or chest physicians, specialize in diagnosing and treating diseases of the lungs and respiratory system. Pulmonology practices handle a wide variety of complex conditions, from asthma and COPD to lung cancer and sleep disorders, which makes the billing process more challenging. At StafGo Health, we offer specialized medical billing and RCM solutions for pulmonology clinics to ensure the correct documentation in the first place, accurate coding, and timely reimbursement. Our team deeply understands the complexity of coding for services like pulmonary function tests, bronchoscopy procedures, sleep studies, and long-term patient management.

Complex CPT Code Management for Pulmonology Practices with StafGo Health

Pulmonology billing involves a wide spectrum of diagnostic and therapeutic procedures, requiring accurate CPT coding for faster reimbursement. Our certified coders have a deep understanding of commonly used pulmonology CPTs, such as 99213–99215 for office visits and 99221–99223 for initial hospital care, 94010 (spirometry), 94760–94762 (pulse oximetry), and 94640 (nebulizer treatment). Our coders are well aware that pulmonary function tests like 94726 (plethysmography) and 94729 (diffusing capacity) are essential for accurate diagnosis and billing, and for more complex procedures, pulmonologists may use codes such as 31622–31628 for bronchoscopy and 95800–95811 for sleep studies.

Why Outsource Medical Billing And RCM To Stafgo Health For Your Pulmonology Practice?

Pulmonology billing requires a comprehensive understanding of various diagnostic tests, complex procedures, and chronic disease management. At StafGo Health, we have a team of specialists who understand the prevalent challenges of pulmonology practices like coding for bundled pulmonary function tests, getting prior authorizations on time, and handling denials related to medical necessity. Outsourcing your Medical Billing and RCM services to us led you to ensures accurate coding, timely claim submissions, and proper documentation to reduce errors and boost cash flow.

Common RCM Challenges Faced by Pulmonology Practices

- Complex Coding for Diagnostic Procedures - Pulmonology procedures like pulmonary function tests (PFTs), spirometry, etc., require precise and complex CPT coding. If Mistakes occur in the application of these codes, it can easily lead to denied claims or lower payments.

Billing Challenges with Sleep Study and CPAP—Billing for sleep studies (95810, 95811) and durable medical equipment (like CPAP machines) is regulated by payer-specific rules, frequent authorization needs, and recurring billing regulations.

Prior Authorization for High-Cost Services - Getting Prior Authorization for High-Cost Services is also a major task faced by Pulmonologists. Many services, like CT scans, CPAP machines, etc. require time-consuming pre-authorizations. Delays in this process can result in delayed billing and payments.
Chronic Care & Follow-Up Visit Management - Pulmonologists often face challenges in keeping track of and recording scheduled follow-ups, documentation, and billing for long-term conditions like COPD, asthma, etc. This adds an administrative burden on them.
Telehealth Billing Complexities— Remote monitoring and telepulmonology services come with variable payer policies and ever-changing billing rules, which lead to confusion, causing irregular reimbursement.
High Denial Rates for Pulmonary Function Tests (PFTs)- Insufficient documentation can lead to denials of tests like spirometry (94010), diffusion capacity (94729), and plethysmography (94726).

Solving Your Pulmonology Practices' Challenges with StafGo Health

Expert Coding for Pulmonary Procedures - At StafGo Health, you will find a team of certified coders with expertise in using pulmonology-specific CPT codes such as 94010, 94760, 95810, 31622, etc. We ensure precise coding and modifier usage to lower the number of denials.

- Improved Documentation Support for Sleep Study and CPAP - Our team assists your staff in maintaining clear and concise clinical documents to prove medical necessity for insurance companies that have strict criteria on respiratory testing and DME claims. This promotes faster reimbursement of claims.

Streamlined Pre-Authorization Management - Our team proactively works to get prior authorizations for several procedures, like diagnostic imaging, CPAP devices, etc., to avoid any kind of delays in treatment or billing lags.

- Optimized Chronic Care & CCM Billing - Our team efficiently manages the full billing cycle of Chronic Care Management for patients with chronic pulmonary conditions like asthma, COPD, etc. We also provide remote monitoring services. This helps in the enhancement of your practice's financial growth.

Billing Support for Telehealth and Remote Services—Our team stays updated with the evolving telehealth policies and helps you bill for virtual visits, remote spirometry, and RPM codes accurately based on payer guidelines.
Documentation Support for PFTs—Our team guides you in documenting the medical necessity for PFTs and other tests, which helps in reducing denials and supporting the appeals.