Rheumatology Billing Services
Relieve your clinic's billing load so your rheumatologists may concentrate on patients. Rheumatology combines chronic disease management, intricate multidrug treatment, infusions, and regular office visits. That combination produces billing complexity: biological medicine delivery, infusion coding, preauthorizations, medical need for high-cost drugs, time-based chronic care codes, and changing payer regulations. At Sirius Solutions Global, we collaborate with rheumatology clinics to capture every right dollar, lower denials, and create billing predictability so your team can concentrate on treating autoimmune disease, arthritis, and difficult complex connective tissue problems.
Our Rheumatology Billing Services
We build workflows around how your practice works clinical workflows, infusion workflows, and patient experience not around one-size-fits-all rules.
Core services we deliver:
-
Accurate coding for rheumatology: CPT, HCPCS/J-codes, and ICD-10 coding that reflect the complexity of autoimmune diseases, procedures, joint injections, and infusion therapy.
-
Infusion & injectable billing: Charge capture for drug units, administration CPTs, supplies, observation time, and correct place-of-service billing (office vs. infusion suite).
-
Prior authorization & appeals: We assemble the clinical packet, submit authorizations, follow up proactively, and mount appeals when payers deny or underpay.
-
Buy-and-bill / J-code management: We manage drug acquisition workflows, unit conversion, and reimbursement reconciliation so you don’t lose margin on expensive biologics.
-
Denial prevention & recovery: Root-cause analysis for denials, fast resubmission workflows, and targeted appeals for high-dollar claims.
-
Support for Chronic Care Management (CCM) and RPM: Templates for documenting, time tracking, and billing methods for codes for continuous remote management.
-
Up-to-date processes for telemedicine billing, modifier use, and payer specifics; telehealth and e-consult billing.
-
With KPI reporting, targeted outreach on unpaid, underpaid, or pending claims.
-
Reporting and analysis: Actionable dashboards for rejection patterns, payer performance, AR aging, net collection rate, and infusion margins.
-
Compliance and audit readiness: Develop audit packages, perform chart audits, and submit correction plans.
Typical outcomes what clients see
While every practice starts at a different baseline, here are measurable improvements practices commonly report after cleaning up workflows and claims:
-
Lower denial rates — fewer denials related to prior authorization failure, coding mismatch, or J-code unit errors.
-
Faster cash flow — improved first-pass acceptance and quicker payer response time.
-
Better infusion margins — correct unit capture and underpayment recovery reduce lost drug revenue.
-
Reduced clinician time on billing — clinicians document efficiently and spend less time on appeals.
-
Actionable business insight — dashboards allow leadership to fix recurring payer or coding problems.
Why rheumatology billing needs specialty expertise
Rheumatology isn’t just E/M visits repeated. A few of the specialty challenges we see every day:
-
Biologic & specialty drug billing: Jcodes, buyandbill vs. medical benefit pharmacy issues, IV infusions, infusion center billing against office management: biological and specialist drug invoicing.
-
Prior authorizations are constant: Because payers want complete documentation for cutting-edge drugs, biologics, and biosimilars, prior approvals are still being processed. Delays cost patients and practices.
-
Chronic care management & CCM codes: Coordinating time-based visits, remote management, and split billing requires disciplined workflows.
-
Infusion therapy complexity: Multiple CPTs, drug units, administration codes, supplies, and observation time must be captured correctly.
-
Bundling and NCCI edits: Procedures, injections, and related services often trigger edits if submitted incorrectly.
-
Frequent audits: High-cost medicines and challenging coding promote pre- and postpay inspections; supporting documents need to be audit-ready.
-
Telemedicine & remote monitoring: RPM, virtual follow-ups, and e-consults all have different coverage rules that must be properly applied under telemedicine and remote monitoring.
Payment may be withheld or refused if documentation or coding fails even one item: a diagnosis specificity, the proper J-code units, or proof of previous conservative treatment.
Infusion & Biologic Therapy - we understand the economics and the paperwork
Infusions are a major revenue source and a major audit target. We focus on:
-
Verifying coverage and benefit type (medical benefit vs. pharmacy) before infusion scheduling.
-
Pre-authorizations that include prior conservative therapy, disease activity scores, lab evidence, and trial documentation.
-
Accurate J-code unit math (dosing conversions, vial waste policies) so claims match what was administered.
-
Proper use of administration CPTs (e.g., 96365 series) and observation codes; separate billing for supplies and infusion-related services where allowed.
-
Coordination with infusion pharmacies and 340B programs when applicable.
-
Tracking patient financial responsibility and clearly communicating costs to patients before therapy starts.
That combination reduces administrative delays and reduces revenue surprises for both the practice and the patient.
Clinical documentation improvement - short templates that preserve clinical nuance
We provide concise, clinician-friendly templates and training to ensure notes support reimbursement and are audit-ready:
-
Crucial components for biological clearances include disease activity scores, previous tried treatment, and laboratory data.
-
Observation notes: drug name, lot/serial, units given, infusion begin/stop times, and documentation checklist.
-
Distinct E/M documentation for same-day procedures or injections (why the visit was separately billable).
-
Time capture templates for CCM and RPM charges.
-
Problem-focused note templates for flare management vs. well-controlled follow-ups.
Good documentation saves time and prevents denials and clinicians appreciate notes that capture clinical care, not paperwork.
Technology & AI - practical, human-guided automation
We use automation and AI where it reduces repetitive error and speeds decisions — never to replace clinical judgment.
-
AI-assisted claim scrubbing: Missing prior authorization, incompatible diagnosis-to-procedure, and unit faults - so coders can fix claims before presubmission using AI-assisted claim scrubbing.
-
Denial risk scoring: Machine learning stresses claims more likely to be denied; hence, human reviewers prioritize them first.
-
Prior auth automation: Templates and supervised procedures speed approvals and enable patients to remain on track.
-
Payment integrity tools: Compare EOBs to contracts to identify underpayments and generate recovery worklists.
-
Smart dashboards: Near real-time KPIs — first-pass acceptance, denial rate by reason, AR days, infusion margins, and payer turn times.
The result: faster payments, fewer denials, and a small, expert team doing higher-value billing work.
Quick Helpful Answers
- 01
- 02
- 03
- 04
- 05
Let’s make your Rheumatology Billing predictable and fair
Rheumatology care is complex and rewarding. Billing shouldn’t slow you down. At Sirius Solutions Global we combine rheumatology billing expertise, practical AI tools, and a human-first approach to get you paid faster and keep you audit-ready. Contact us today to schedule a complimentary revenue cycle assessment and baseline audit.