Pulmonology Billing Services
Assist patients and give your revenue cycle some freedom. Pulmonology care includes everything from hospital visits to outpatient clinics, sleep medicine, pulmonary rehabilitation, and home breathing assistance. Such clinical breadth causes billing complexity, as process-heavy claims, time-based critical care, DME/oxygen norms, prior permissions for expensive biologics, and changing payer policies all result from it. Your physicians may focus on life and lungs rather than paperwork thanks to Sirius Solutions Global Systems.
Our Pulmonology Billing Services end-to-end, specialty-focused
We design workflows that reflect how pulmonology practices actually work: fast, precise, defensible.
1. Specialty Coding & Chart Review
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Correct CPT/ICD10/HCPCS codes for spirometry, lung volumes, diffusion, bronchoscopy with biopsy/brushings, thoracentesis, chest tube operations, sleep studies, and pulmonary rehabilitation.
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Pay special attention to bundling/NCCI modifications as well as suitable usage of modifiers (RT/LT, 26/TC, 59/XS, etc.).
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Clinical chart review for matching diagnoses with procedure-level medical need.
2. DME & Home Respiratory Equipment Billing
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Verification of coverage and permanent medical device records for oxygen concentrators, portable oxygen, home ventilators, and CPAP/BiPAP devices.
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Proof-of-delivery management, supplier compliance, and policies for replacement/repair.
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Coordination between supplier and clinical documentation to avoid denials.
3. Claims Submission & Payer-Specific Edits
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Before submission, clean claim scrubbing utilizing payer rules, LCDs, and regional policies helps to raise first-pass acceptance.
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Electronic submission and follow-up processes help to minimize payment delays.
4. Prior Authorization & Specialty Drug Support
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End-to-end preauthorization management for complicated treatments, biologics, and expensive procedures.
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Clinical packet construction (progress notes, previous conservative treatment, imaging/pulmonary tests) speeds along approvals.
5. Denial Management & Appeals
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Root cause analysis for rejections based on medical necessity, documentation issues, bundling, and DME mistakes.
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Quick appeals accompanied by clinical links and addenda as needed.
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Trend removal: We correct the process, generating several rejection letters.
6. Revenue Cycle Management (RCM) & A/R Follow-up
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Payer reconciliation, targeted follow-up for high-dollar claims, and accounts receivable aging reduction.
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Contract compliance evaluation to find recovery possibilities and uncover underpayments.
7. Compliance & Audit Readiness
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HIPAA-compliant procedures, internal coding audits, and documentation templates protect your claims during audits and outside inspections.
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Regular revisions when payer policies, NCCI corrections, or LCDs evolve.
8. Reporting, KPIs & Financial Insights
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Dashboards for first-pass acceptance, rejection causes, A/R days, net collection rate, and payer performance.
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Actionable insights help you to set priorities for fixes that change the needle.
Benefits of partnering with Sirius Solutions Global
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Fewer denials and faster cash flow through specialty-specific pre-submission edits.
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Reduced administrative burden so clinicians spend more time with patients.
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Better payer compliance and lower audit risk.
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Higher first-pass acceptance and improved net collection rates.
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Clear financial visibility via tailored reports and KPIs.
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Prior authorization throughput that reduces treatment delays.
Why pulmonology billing is different
Pulmonology mixes routine visits with technically complex and high-cost services. Common pain points we see:
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Procedures range from bronchoscopy with biopsies, thoracentesis, chest tube management, pulmonary function tests (PFTs), and bronchial thermoplasty; all call for exact CPT/HCPCS coding and appropriate modifier use.
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Ventilator management and ICU time call for precise time capture and justification as part of time-based critical care and observation.
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Home oxygen, concentrators, and ventilators need thorough documentation, proof of delivery, and supplier rules in DME and oxygen treatment.
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Sleep medicine crossovers sleep studies, home sleep testing, and CPAP supplies follow distinct coverage paths and usually need explicit medical need documentation.
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Monoclonal antibodies and other specialty treatments need prior permission, updated clinical justification, and occasionally complicated billing via medical benefit versus pharmacy benefit.
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Coverage for procedures and equipment can vary by MAC and payer; what pays in one region may be denied in another. Frequent payer edits & regional LCDs.
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High audit risk: payers and auditors carefully examine expensive processes and sturdy gear.
Revenue leakage is unavoidable if your team is juggling all that while running patient care.
Specialized billing scenarios we handle every day
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Pulmonary Function Testing (PFTs) — correct panel coding, reflex testing rules, repeat testing limits, and technician vs. physician components.
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Bronchoscopy & Advanced Airway Procedures — multiple procedure rules, pathology add-ons (biopsy, cytology), anesthesia modifiers where relevant.
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Critical Care & Ventilator Management — time-based critical care codes, ventilator management documentation, observation vs. inpatient rules.
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Sleep Medicine — in-lab polysomnography versus home sleep apnea testing (HSAT), CPAP titration, billing of supply, and coverage validation.
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Home Oxygen & Home Ventilators (DME) — supplier coordination, POD, replacement eligibility, and Medicare caps/coverage checks.
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Pulmonary Rehabilitation — time-based group vs. individual billing, progressive treatment documentation, and payer-specific coverage.
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Biologic & Specialty Therapy Billing — medical benefit submission, J-codes/HCPCS, and coordination with infusion centers or specialty pharmacies.
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Occupational/Environmental Lung Claims — work-related exposures, linkages to workers’ comp when applicable.
Compliance, security & audit defense
Pulmonology’s high-value services invite scrutiny. We build airtight processes:
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HIPAA and HITECH-compliant data handling.
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Regular coding audits and corrective action plans.
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Documentation templates aligned with CMS guidance and payer LCDs.
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Audit-ready packet preparation (clinical notes, imaging, PFTs, DME POD) for rapid responses to requests.
AI & Technology: smarter billing with a human touch
We combine automation and expert judgment so your revenue cycle runs like a well-tuned machine:
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Pre-submission AI Scrubbing — flags coding mismatches, missing modifiers, and documentation gaps before claims go out.
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Denial Prediction Models — score claims by risk and prioritize human review on those most likely to deny.
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Automated Prior-Auth Tracking — reduces manual status checks and prevents treatment delays.
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Smart Reconciliation — auto-match ERA/EOBs, identify underpayments, and queue recovery tasks for staff.
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Actionable Dashboards — near real-time metrics so clinical and administrative leaders can make fast decisions.
We never let automation replace clinical nuance AI finds likely problems; experienced coders and clinicians decide the fixes.
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