rcm solutions Rheumatology facilities

Medical Billing And Revenue Cycle Management Solutions For Rheumatology Facilities

Rheumatology providers are specialists who diagnose and treat diseases affecting the musculoskeletal system, including joints, muscles, and bones. At StafGo Health, we focus on providing customized medical billing and RCM solutions that are mapped out specifically for rheumatology practices. Rheumatology involves several complex events like changing treatment plans, specific medications, and frequent follow-up visits, which require a unique set of strategies. Our experienced billing specialists deeply understand the nuances of CPT, HCPCS, and ICD-10 codes that could impact your bottom line.

Well Managed Billing For Your Rheumatology Practice With Our Certified Coders

Rheumatology billing consists of a wide spectrum of complex services that require accurate CPT coding to ensure proper and quick reimbursement. Our coders are very efficient in the application of the most likely used CPTs, like 99213, 99214, and 99215 used for office visits based on complexity and time, for drug administration and infusion services, codes such as 96365 (IV infusion, initial, up to 1 hour), 96372 (therapeutic injection, subcutaneous or intramuscular), and 96413 (chemotherapy administration, IV infusion), which are frequently billed, especially for biologic therapies like Remicade or Humira. Our team is well aware that the joint injection procedures may be coded with 20610 (major joint aspiration/injection) or 20611 (with ultrasound guidance) and that the diagnostic testing services like 85025 (CBC with differential) and 86140 (C-reactive protein) are also critical for monitoring autoimmune conditions.

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

Rheumatology practices encounter a unique set of billing challenges due to the complications associated with services like biologic infusions, chronic care management, etc. If you outsource your Medical Billing and RCM to StafGo Health, we can supply you with the special Revenue Cycle Management (RCM) services made for the specific needs of rheumatologists. Our skilled team is experienced in the use of high-level codes and infusion and injection coding to avoid unnecessary denials. With us, you will have a dedicated partner who can reduce the administrative burden remarkably, enhance your cash flow, and improve the overall financial health of your practice.

Common RCM Challenges Faced by Rheumatology Practices

Complex Drug & Biologic Infusion Billing - Rheumatology practices generally use very expensive biologics and specialty drugs. Misuse of HCPCS coding, wrong units listing, and wrong use of J codes can result in claim denials and underpayments.
Prior Authorization and Payer-Specific Criteria - Many treatments in Rheumatology Practices require time-sensitive pre-approvals from insurance companies. Failure or delays in getting prior authorizations for some important drugs like infliximab can lead to claim rejections and delayed care cycles.
Accurate Coding for Chronic Care Management (CCM) - It is highly important to code accurately for a chronic condition. Chronic condition tracking codes are usually underutilized by payers or improperly documented by office staff. This can lead to a loss in revenue for ongoing patient monitoring services.
Modifier Misuse and Incorrect E/M Leveling - Use of incorrect modifiers or selecting the wrong E/M (Evaluation and Management) code for detailed rheumatology exams can highly affect both compliance and how much money you get paid by the payer.
High Denial Rates from Incomplete Documentation- Insurance payers frequently ask for thorough and detailed documentation to prove the need for biologic therapies. Incorrect treatment logs, diagnosis support, or time-based details can cause audits or payment delays.
Absence of Specialty-Focused RCM Resources- General billing services do not have comprehensive knowledge of codes and modifiers, which are specific to rheumatology. They also lack knowledge about infusion billing rules and documentation needs, preventing reimbursement precision and operational efficiency.

Solving Your Rheumatology Practice's Challenges with StafGo Health

Expertise in Biologic Infusion Coding & J-Code Management- Our team of experts precisely codes and audits HCPCS J-codes to ensure the use of correct units, NDCs, and dosage calculations. This can inhibit the underbilling and denied claims for your costly procedures.

Automated & Timely Prior Authorization Handling - Our team proactively looks after the prior authorizations for specialty drugs and therapies to make sure that there are no delays in care delivery. With the help of our advanced tools, we can track approvals and resubmit requests in real-time.
Maximize Chronic Care & Remote Monitoring Reimbursements- Our Revenue Cycle Management (RCM) workflows ensure compliant billing for critical codes. We provide comprehensive documentation support to your office staff to ensure consistent revenue streams.
E/M Coding and Modifier Accuracy Audits - We conduct periodic audits of your Evaluation & Management billing regularly to assure correct use of levels and modifiers for separate services. This can enhance your compliance and make sure the payment is consistent.
End-to-End Documentation & Denial Management - StafGo Health provides support to your clinical team in documentation templates and also educates them to meet payer standards. Our team also provides help to track, appeal, and resolve denials, leading to fewer revenue losses.
Real-Time KPI Tracking for Your Rheumatology Practice - Our customized dashboard tracks all the key metrics like Denial rates by biologic or service type, Days in A/R segmented by payer, Net reimbursement per infusion, etc. These insights give you an overview of your practice’s financial performance.