Our Endocrinology Billing Services
1. Eligibility & Prior Authorization Management
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Pre-visit insurance verification and benefit extraction (co-pay, deductible, DME coverage).
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Prior-auth triage for expensive devices, biologics, and high-cost procedures; clinical packet prep and payer follow-up.
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Coordination for supplier enrollments so DME/device claims process quickly.
2. Specialty Coding & Charge Capture
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Accurate coding for endocrine-specific visits and procedures, time-based counseling, medication management, and complex decision-making.
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Correct distinction between evaluation/management services and care-management programs.
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Charge reconciliation against visit notes, device logs, and infusion/supply records.
3. Device, DME & Supplier Coordination
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Reconcile manufacturer/supplier invoices to claims to prevent device denials and lost device revenue.
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Verify supplier enrollment and billing permissions to avoid payer rejections.
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Capture serial numbers, lot numbers, and device documentation when required.
4. Remote Monitoring & Chronic Care Program Billing
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Setup and billing support for remote monitoring and chronic care initiatives, including consent capture, time tracking, and monthly reporting workflows.
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Integration with monitoring vendors and clinical teams to collect required data and documentation.
5. Claim Scrubbing, Submission & Clearinghouse Management (AI-Assisted)
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Automated pre-submission scrubs for payer edits, modifier conflicts, and demographic mismatches.
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Intelligent ranking of claims by denial risk so humans review the ones that matter.
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Clearinghouse submission, daily rejection handling, and corrected resubmission.
6. AR, Denial Management & Appeals
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Prioritized AR workflows focusing on high-dollar and high-likelihood recoveries.
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We put together appealing bundles comprising lab trends, chart extracts, and clinical justifications for medical need.
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Root-cause analysis and remedial measures enable one to prevent repeating rejection patterns.
7. Reporting, Analytics & Provider Scorecards
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Days in AR, denial rate, first-pass approval, net collection rate, and program income (e.g., RPM, DME) dashboard monthly.
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Provider ratings are based on focused document suggestions connected to revenue leakage.
8. Compliance & Audit-Ready Documentation
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To ensure defensible coding and medical necessity, chart sampling and documentation reviews.
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Proper handling of PHI, BAAs, role-based access, and encrypted data transmissions.
Benefits of Partnering with Sirius Solutions Global
Quicker payments come from streamlined billing processes. Certified coders reduce claim mistakes. Release your team for patient care by lowering administrative load. Customized services for solo practitioners, team practices, and multi-specialty clinics. Comprehensive reports to increase operational efficiency.
98%
Clean Claims
50+
Specialities
97%
Client Retention
35+
States Served
Key Services for Endocrinologists
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Accurate CPT & ICD-10 coding for endocrine disorders.
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Chronic care management (CCM) billing.
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Lab and diagnostic billing for thyroid, pituitary, and adrenal tests.
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Prior authorization management for hormone therapies.
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Denial analysis & appeals.
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Compliance audits for HIPAA & payer guidelines.
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Credentialing & payer enrollment.
Why endocrinology billing needs a specialist approach
Endocrinology isn’t “just” office visits. You bill for device services (CGM downloads and interpretation), diabetes self-management and nutrition education, remote monitoring, infusion or drug therapy oversight, bone density testing, and complex follow-ups. Each of these areas has payer-specific rules that change often — so a specialist billing workflow prevents missed revenue and reduces audit risk. For example, continuous glucose monitor (CGM) coverage and coding requirements are governed by specific Medicare policy and PDAC device listings; billing CGM incorrectly is a frequent source of denials.
Endocrinology Billing Services
Automation-powered streamlined billing solutions for endocrinology clinics aided by artificial intelligence
Endocrinology blends routine visits with high-complexity, technology-driven care: CGMs, insulin pumps, DSMES/DSMT, RPM, bone health procedures and specialty biologics. At Sirius Solutions Global we combine endocrinology billing expertise with AI-assisted workflows and human review so your practice captures every appropriate dollar while protecting patient trust and payer compliance.
Endocrinology Medical Billing, Explained
Endocrinology billing centers on the whole revenue cycle for endocrine practices diabetes care, thyroid disease, and hormone therapies, among others. Specialized teams manage insurance checks, accurate coding, claim submission, denial follow-ups, and payment posting so practices are suitably compensated and may concentrate on patient care. Firms like I-Med Claims, CureMD, and PCH Global offer these services for the complex world of endocrine diagnoses and tests.
What Is Endocrinology Billing?
It offers billing specifically designed to meet the requirements of diabetes, thyroid conditions, and hormone imbalances that of the endocrine system. The objective is correct: uniform compensation for thyroid treatments and hormone treatment.
Specialized Focus
Deep familiarity with endocrine conditions ensures the right codes and documentation are used for complex cases.
Key services we optimize for endocrinology
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Proper HCPCS/CPT mapping ensures that the equipment complies with PDAC listing through CGM configuration, download, and analysis (CPT/HCPCS management).
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Diabetes self-management education and training (DSMT/DSMS/DSMT) is defined by accreditation, appropriate usage of Medicare DSMT codes G0108 / G0109, and staffing and credential requirements.
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Remote physiological monitoring (RPM) and remote therapeutic monitoring (RTM) are defined by the correct use of 99457/99458, the device against treatment-management instructions, and data demands for compensation.
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Medicare/Medicaid Medical Nutrition Therapy (MNT) and correct G-codes.
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DEXA (bone density), pathological reconciliations, and thyroid ultrasound tests are among endocrine system and imaging reconciliations.
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Anti-resorptives for osteoporosis, biologics, or certain diabetic drugs needing permission are among complex pharmaceuticals and previous approval protocols.
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Audio-only telehealth appointments are observed with payer-specific modifiers and consent where allowed.
Choosing the Right Partner
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Experienced with endocrine abnormalities and the pertinent billing codes, specialized knowledge.
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Tailored workflows: Processes that suit your emphasis—diabetes care, thyroid health, or pediatric endocrinology.
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Comprehensive RCM: One coordinated team spanning every stage of the revenue cycle.
What makes endocrinology billing different
Endocrinology blends high-volume primary care-style visits with specialist device and program billing. Typical difficulties include:
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Numerous kinds of appointments exist: short follow-ups, complicated drug management, and time-based therapy.
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Device and DME invoicing insulin pumps, CGMs, and supplies demands invoice reconciliation and supplier enrollment.
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Codes for chronic care and remote monitoring call for particular documentation and time tracking.
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Frequent early permissions for DME and specific diabetes treatments as well as biologics.
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Close link between clinical documentation and medical need (trends, dose titration notes, labs).
Fixing these points at intake, charge capture, and claim submission speeds payments and lowers denials.
10-Point Endocrinology Billing Audit
1. Are CGM device and supplier codes validated against the PDAC/PCL before billing?
2. Is your DSMT/DSMS program accredited and are G0108/G0109 entered correctly in the charge master?
3. Do RPM/RTM services meet 16-day data collection rules where applicable and meet device/monitoring definitions?
4. Are telehealth modality and consent documented per payer rules?
5. Are prior authorizations triggered automatically for specialty endocrine meds?
6. Are DEXA and pathology attachments reconciled to procedural claims?
7. Is split-visit logic (E/M + procedure) audited and modifiers applied correctly?
8. Are denials root-caused and process changes tracked monthly?
9. Are patient outreach scripts empathy-first with payment plan options?
10. Are audit trails kept (who edited the claim and why)?
CTA: Download the Endocrinology 10-Point Audit — Get a free baseline review for one clinician.
7 actions that protect revenue
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Device compliance & CGM coding verification — We check PDAC/HCPCS listings and apply the right supplier/provider billing path so CGM claims don’t fail.
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Accredited DSMT/DSMS billing — We ensure program accreditation, correct session-level billing (G0108/G0109), and supporting attendance documentation is attached.
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RPM / RTM integration — Our RCM supports device provisioning, data collection thresholds, and the correct physician/clinical staff billing rules for 99457/99458 and related codes.
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Prior auth automation for specialty meds — We kick off PAs at order time, collect required clinical attachments, and track expirations so therapy isn’t delayed.
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Telehealth readiness & documentation — We capture modality, consent, and place-of-service rules to support telehealth claims and to avoid modality-based denials.
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Pre-submission scrubs tuned to endocrine patterns — flags for CGM, DSMT, infusion/biologic codes, DEXA, and frequent endocrine denial drivers.
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Human-in-the-loop appeals — AI drafts evidence-based appeals while hospice-trained coders (sic: endocrinology-trained coders) finalize and submit for higher overturn rates.
How our AI helps - speed plus human checks
AI is used to remove repetitive work and surface risk — not to replace clinical judgment:
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Automated OCR and chart parsing extract key lab trends, medication titration notes, and device usage data to pre-populate claim fields.
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Predictive denial scoring identifies claims at elevated risk so coders focus there first.
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Smart templates assemble prior-auth packets using chart excerpts, provider notes, and guideline references.
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Continuous learning loop improves scrub rules using outcomes from resolved denials.
Every critical decision prior authorization submission, appeal content, or medical-necessity determination is reviewed by a trained human specialist.
How Sirius Voice AI & Sirius AI Billing Engine help endocrinology
Sirius combines clinically coded intelligence with compassionate voice interactions:
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Device & education logistics: Voice AI confirms addresses, teaches simple device steps, and answer clinical questions to staff.
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Authorization checks & follow-ups: Artificial intelligence queries payer portals and flags missing approvals for human review.
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RPM and CGM triage: Automated detection of data gaps or device failure reports triggers immediate staff intervention.
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Empathy-first patient financial conversations: Voice scripts designed to preserve the patient relationship while resolving balances.
Every AI action is auditable, encrypted, and supervised by humans the AI does the routine work, your clinicians do the care.
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Partner with the Endocrinology Billing Experts
Endocrinology calls for regular and correct billing assistance from first patient visits through long-term treatment programs. Your reliable partner in reaching enhanced cash flow, fewer denials, and total compliance is Sirius Solutions Global. Today, call us to find out how we might improve your endocrinology billing income and speed.