Sleep and ventilator billing is documentation, not coding.
Pulmonology claims are usually correct on the code and wrong on the paperwork. Sleep studies, home ventilation and pulmonary rehabilitation all pay on documentation a payer will ask to see.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Pulmonology claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Sleep studies billed without qualifying documentation
Home and in lab studies have qualification criteria and prior authorization rules. Billed without them, the study is performed and never paid.
- Home ventilation recertification missed
Ongoing equipment and ventilation require periodic recertification. Miss the date and payment stops without a denial arriving to warn you.
- Pulmonary rehab sessions past the limit
Rehabilitation is capped per condition and per period. Sessions beyond the cap are delivered at your cost.
What we bill for Pulmonology practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Pulmonology accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A pulmonology coder, not a general one
The coder assigned to your account works pulmonology every day. They already know which of your payers do what, and they are watching sleep study qualification, ventilator documentation and rehab session limits.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in pulmonology it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your pulmonology claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Pulmonology practices
- Coders who work pulmonology daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Pulmonology billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Pulmonology service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Pulmonology practices ask
Do you handle prior authorization for sleep studies?
Yes, before the study rather than after the denial.
Can you track recertification dates?
Yes. It is a calendar problem more than a billing problem, and it is exactly the kind of thing a busy practice drops.
Do you bill the DME side too?
We bill what you provide. If a separate supplier bills the equipment we coordinate so the two claims do not collide.
What about critical care time?
Critical care is time based and heavily reviewed. We bill it from documented time only.
Have a pulmonology coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.