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Results-Driven Pulmonology Billing Solutions
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Overview of Pulmonology Billing Services
Around 35 million people in the USA suffer from chronic respiratory diseases like asthma and COPD. The U.S. Centers for Disease Control and Prevention reports that such conditions are the 6th leading cause of death in the country, taking away 147,382 lives each year. Emergency departments and pulmonologists are overwhelmed by the rising number of visits, leaving little to no time for billing and claim filing.
Professional pulmonology billing services cover all steps of the insurance billing process, ensuring that providers are rightfully reimbursed without losing their focus on rendering quality patient care. Our comprehensive services include the following.
Common Challenges in Pulmonology Medical Billing
The claim denial rate for pulmonology practices is on the higher end of the spectrum. The average claim denial rate in pulmonary medicine is 18%, while the median denial rate for all specialties combined is between 5% and 10%. This goes to show that inefficiencies and errors frequently derail the pulmonology billing process, leading to claim rejections, insufficient payment collection, and revenue reduction.
However, by overcoming common challenges in pulmonology medical billing, like hasty verification and precertification, coding inaccuracies, incomplete documentation, non-compliance, and limited billing knowledge, you can reduce the rate of denials and propel your practice toward financial success.
Multitude of Respiratory Conditions
Pulmonology, or pulmonary medicine, is a complex specialty. It involves diagnosing, treating, and managing a wide range of respiratory conditions, like COVID-19, asthma, lung cancer, and chronic obstructive pulmonary disease (COPD). Each disease or condition requires a separate testing and treatment procedure, making coding and billing extremely complicated.
Need for Prior Authorizations
Government and private insurance payers only cover and reimburse medically necessary pulmonology services. Hence, for specialized procedures and services, like sleep studies for sleep apnea, lung biopsies, and pulmonary function tests, preauthorizations must be sought from payers. However, obtaining preauthorizations can take weeks, delaying timely patient care.
Inadequate Documentation
Accurate and complete documentation is one of the payer requirements. Insurers expect providers to submit supporting documents with the claim form to prove the medical necessity of the procedure and its impact on patient health. However, organized record maintenance can be difficult because providers often write clinical notes by hand.
Changing Rules & Regulations
From government regulations to payer policies, pulmonology billing rules and guidelines change frequently, making it challenging for healthcare providers to keep up and ensure compliance at every step of the process. Moreover, non-compliance can lead to claim denials, fines/penalties, or lawsuits, jeopardizing the practice’s reputation and financial health.
Outsource Pulmonology Billing Services to MediBillMD
Outsourcing pulmonology medical billing services can not only offload the burden of administrative tasks from your staff’s shoulders but can also make the process more cost-effective. Time and again, it has been proven that outsourcing is more affordable than setting up an in-house billing team. Instead of hiring, training, and retaining staff, you can entrust pulmonology billing to a team of professionals who become an extension of your practice.
At MediBillMD, we use industry best practices to offer tailored, low-cost, streamlined, compliant, and proven medical billing and practice management solutions for end-to-end revenue cycle management. With us by your side, you can seamlessly grow your practice and reach the pinnacle of financial success.
Whether you opt for our full stack of pulmonology billing services or pick and choose based on the unique needs of your practice, we only charge a small percentage of your gross monthly collections. Our industry-low rates are a testament that superior quality can be delivered without charging premium fees.
We use a centralized system for task delegation, data verification, efficient two-way communication, record-keeping, and tracking. It helps us streamline our pulmonology billing workflow and ensures every task is completed systematically with extreme precision and diligence. Moreover, the system integrates with your existing software, giving you complete access to files.
The MediBillMD task force comprises AAPC-certified professional coders with years of experience in medical coding. They are familiar with standardized coding systems like CPT, ICD-10-CM, HCPCS, and CDT and assign each code to the highest degree of specificity for coding accuracy. They are trained to eliminate coding confusion.
We are 100% HIPAA-compliant and ISO-certified. Our processes are regularly audited and amended to be in conformance with the latest industry regulations. For example, we implement password protection and end-to-end file encryption to safeguard our clients’ and patients’ sensitive information from data breaches.
Serving 50 states in 50 ways! Let us be your breath of fresh air for pulmonology billing. At MediBillMD, we are resolved to provide field-tested pulmonology billing services to small, medium, and large practices in every corner of the country. Our virtual setup allows us to deliver billing and revenue cycle management excellence in bustling downtowns as well as remote communities, transforming pulmonology practices regardless of time and distance.
Overcome Pulmonology Billing Challenges with MediBillMD
From coding mistakes to incomplete documentation and varying payer requirements to ineffective patient communication, pulmonology medical billing is marred with several challenges. At MediBillMD, we use our deep industry knowledge and skills to expertly navigate these common pitfalls and ensure clean and compliant claim submissions. Our billing services for pulmonology practices include data verification, efficient communication, claim scrubbing, and audits to mitigate errors and secure timely payments.
| Common Pulmonology Billing Challenges | MediBillMD Solution | |
|---|---|---|
| Not Meeting Medicare’s Requirements for Billing Pulmonary Rehabilitation Services | Medicare has specific requirements for rendering and billing pulmonary rehabilitation services. We stay abreast of these guidelines and ensure that Medicare beneficiaries receive the services and are billed accordingly. | |
| Not Communicating Patient Financial Responsibility to Medicare Beneficiaries Before Rendering Pulmonary Rehab Services | Medicare beneficiaries receiving pulmonary rehabilitation services under Part B are responsible for 20% of the costs. We ensure that this patient financial responsibility is duly communicated to them. | |
| Not Obtaining Prior Authorizations for Specialized Pulmonary Services (for example, home health services and equipment, or tests like bronchoscopy) | Medical claims are denied if prior authorizations are not sought for specialized services. We study the payer requirements and fast-track preauthorizations to expedite patient care and prevent denials. | |
| Failing to Submit Complete Documentation with Medical Claims (for example, physician’s referral letter, detailed and signed reports for findings, etc.) | Accurate and complete documentation is required to prove the medical necessity of procedures and collect payments. Our team gathers all the supporting documents and submits them with the claim form. | |
| Coding Confusion While Assigning Codes for Similar But Distinct Pulmonary Procedures (for example, using 99213 instead of 99214 for RSV testing) | Many pulmonary diagnoses, procedures, and services are similar, leading to coding errors. Our AAPC-certified coders excel in accurate medical coding and use modifiers where needed to give more details. | |
| Separately Billing Services That Must Be Bundled and Reported As A Single Code (for example, billing medications, hospitalization, and equipment, which are part of the COPD care bundle | Several pulmonary services are bundled and denoted by a single code for streamlined billing and cost-effectiveness. We follow the coding guidelines for bundled services to avoid separate/duplicate billing. | |
Lowest Prices Guaranteed
MediBillMD - Offering unbeatable value at unbelievably low prices! Get specialized and custom-made pulmonology billing solutions at flat 1% of collections for the first month of service. Highest returns on investment guaranteed!
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Pulmonology Billing Experts
Entrust your pulmonology billing in the capable hands of our experts. Reach out to our team of medical billing specialists and get timely assistance for bottom-line success.
FAQs
At MediBillMD, we evolve based on the changing needs of your practice. Our pulmonology billing services are flexible, customizable, scalable, and affordable, helping you cherry-pick the solutions, tailor them, and scale them up or down at rates as low as 1% of your net collections. Our diverse team of expert billers and coders files clean and compliant medical claims in the shortest turnaround time to ensure you get accurate reimbursements on time.
Outsourcing pulmonology medical billing services to MediBillMD can lead to incredible savings. The average cost of outsourcing pulmonology billing is 4-10% of net collections. However, at MediBillMD, we charge half of that. Our service fee is 2-5% of your gross monthly collections, and the deal gets sweeter with our flat 1% promo rate for the first 30 days of service.
Translating medical services to standardized codes is the most challenging aspect of pulmonology medical billing. Besides assigning the most appropriate codes and modifiers, the coder must be mindful of bundled and unbundled services and their correct codes to submit accurate claims and prevent denials.
