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Running a pulmonology or pulmonary practice today means more than caring for patients with asthma, COPD, sleep apnea, or lung disease. You also need to manage revenue, avoid denials, and ensure proper coding. Without expert pulmonology billing services, revenue losses can quietly eat into your bottom line—and steal time from patient care.
Below, we explain what pulmonology billing is, why it’s so challenging, and how outsourcing to specialized pulmonology medical billing services can help your practice boost revenue, improve collections, and stay compliant. We also supply actionable tips, industry data (2025), and a clear call to action.
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What Is Pulmonology Billing?
Pulmonology billing refers to the administrative, code-driven process of getting paid for services delivered by pulmonary medicine providers. This includes:
- Translating clinical services into CPT codes and ICD-10 diagnosis codes
- Verifying insurance eligibility and payer policies
- Submitting claims and following up on denials and rejections
- Performing claim adjudication, payment posting, and collection tasks
In practice, pulmonary practice billing work hand in hand to ensure accurate claim submission and compliance with payer rules. Revenue cycle management (RCM) in pulmonology also involves ensuring that documentation supports medical necessity. Without accurate code use, proof of respiratory test results, physician orders, or proper modifiers, many claims are rejected or denied.
Common Challenges That Hurt Revenue
Pulmonology reimbursement is complex. Here are frequent pitfalls that reduce revenue:
| Problem | Effect on Revenue & Collections |
|---|---|
| Coding errors (wrong CPT codes, missing modifiers) | Leads to denials, underpayment; delays in reimbursement. |
| Incomplete or weak documentation | Payers reject claims or require appeals, slowing down revenue and increasing administrative burden. |
| Updated or confusing payer policies | Practices may unknowingly fall out of compliance, risk penalties, and have more rejected claims. |
| High denial rates | Much time spent on resubmission, appeals; cash flow suffers. | Bundled services or incorrect use of modifiers | E.g. pulmonary rehab or combined services that should use specific codes or modifiers. Mistakes can trigger rejections. |
Because of these, many pulmonology practices see denial rates in the 15-25% range unless they have strong processes or expert billing support.
Additional Pulmonary Rehabilitation Sessions with KX Modifier
The patient may require an additional 36 sessions for COVID-19 if he/she has already received pulmonary rehabilitation services for COPD initially or vice versa. When billing for these additional sessions for the second approved condition, providers must append the KX modifier to the second 36 sessions.
Why Outsource to Specialized Pulmonology Medical Billing Services
Outsourcing your pulmonary practice billing and RCM can significantly increase revenue, reduce administrative burden, and improve the end-to-end billing process. Many clinics find that choosing billing services for pulmonology ensures accurate coding, faster reimbursements, and better compliance with payer regulations. Here’s how:
Certified coders and expertise:
Specialists in pulmonary medicine know which CPT codes to apply (for example, for pulmonary function tests, sleep studies, bronchoscopy, or pulmonary rehab), how to use modifiers correctly, and how to document medical necessity. A certified coder will help avoid denials.Denial management and prevention:
Expert billing services proactively identify patterns of rejection/denial, appeal denials efficiently, and reduce their occurrence. Fewer denials mean smoother collection and better revenue.
Faster turnaround on reimbursement and collection:
A specialized team that handles prior authorizations, eligibility verification, correct code submission, and fast follow-ups ensures your claims are accepted the first time. That boosts cash flow.Compliance and risk control:
Regulatory changes — Medicare, CMS, HIPAA-compliant standards, and payer rules — are constant. Outsourcing ensures that your practice stays compliant, reducing risk of audits or penalties.Focus on patient care:
Offloading administrative, coding, billing, and denials work allows pulmonologists and staff to concentrate on clinical care rather than paperwork. In the long term, that can improve patient outcomes and satisfaction, which in turn supports revenue.
Use technology where possible: claim scrubbers, AI tools for coding suggestions, dashboards to monitor payer performance, and billing workflows that support remote patient monitoring services. (AI is trending strongly in RCM in 2025)
To maximize revenue, whether you outsource or manage in-house, ensure that this framework is in place:
- Use pulmonology expertise coders who know the nuances (key CPT codes, modifiers, pulmonary rehab codes).
- Ensure documentation is complete: physician orders, test results, clinical necessity.
- Pre-verify insurance eligibility and get necessary prior authorizations before performing costly procedures.
- Maintain clean claim rate: submit accurate claims first time as much as possible.
- Track key metrics: denial rates, days in accounts receivable (AR), collection rate.
- Use technology where possible: claim scrubbers, AI tools for coding suggestions, dashboards to monitor payer performance. (AI is trending strongly in RCM in 2025)
How to Choose the Right Billing Partner or Manage In-House Successfully
Here are some typical improvements practices see when implementing or outsourcing excellent billing services for pulmonology practices:
- Up to 30-40% reduction in denials within 3-6 months
- 15-25% increase your revenue through higher collections and net reimbursement
- Faster reimbursement cycles (claims paid more quickly)
- Lower administrative overhead (staff freed from chasing claims)
- Better compliance & fewer audits or payer penalties
Real-World Impact: What You Can Expect
When practices outsource billing services, they gain access to certified coders and billers. These professionals manage claim submissions, payer audits, and denial follow-ups.
Outsourcing also allows nephrologists to focus on kidney care rather than revenue cycle management. The result is a streamlined workflow that supports better patient outcomes and practice management.
Take Action: Maximize Your Practice’s Financial Health
If you’re a pulmonologist or pulmonary clinic:
Request an Audit
Let experts analyze your current pulmonology billing process. Identify where you lose revenue — wrong codes, denials, delayed claims, payer rejections.Outsource or Partner with Specialists
Choose a pulmonology medical billing service with certified coders, strong denial management, and proven RCM results.Invest in Training & Tools
Even with outsourcing, your clinical staff must document thoroughly; your in-house admin should understand key CPT codes and compliance requirements.Track Metrics Religiously
Monitor denial rates, days in AR, collection percentage. If you don’t measure these, you can’t improve.
Ready to Transform Your Revenue?
Stop losing revenue over coding mistakes, claim denials, or payer confusion. When you choose our advanced pulmonology medical billing services, you get certified coders, full denial management, faster reimbursements, and better collection performance — all while we ensure compliance every step of the way.
Contact Portiva today for a free audit of your pulmonary practice billing workflow. Discover how much revenue you could be recovering and how quickly your collections can improve.
