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First-Pass Claim Acceptance Rate Across Respiratory Payers
Claim Submission Turnaround After Procedure Documentation
Insurance Payers Including Medicare Advantage and Medicaid Plans
Pulmonary Function Test Billing Audit Compliance Across All Claims
At Credex Healthcare, every pulmonology claim has to go through a four-point review before it can be sent. This review is based on the exact failure points that make up respiratory medicine bills. We can confirm that the lung function test CPT code chosen 94010 for spirometry, 94726 for diffusion capacity, or 94729 for diffusing capacity with the full test battery exactly matches the test that was done and the records that show how it was done.
There is an ICD-10 diagnosis code that goes with nebulizer and breathing treatment codes like 94640. This code tells the payer as much information as they need about the short- or long-term lung disease being treated. We check again to make sure that any mixed lung function test set is paid under the correct complete code and isn’t split up in a way that would get NCCI turned down. We also check to see if the prior permission is still good for tests and treatments that the patient’s insurance company needs to agree to before it will pay for. What’s the difference between a 98% first-pass rate and a 78% one in real life? These four tests show it.
Our pulmonology billing services in the USA cover the following:
We prepare and send pulmonology claims online within 24 to 48 hours of receiving signed paperwork. Before each transfer, we make sure that all necessary modifiers, confirmed CPT codes, ICD-10 lung diagnosis codes, and maximum first-pass acceptance are applied.
We make sure that pulmonologists, respiratory therapists, and sleep medicine providers are approved by Medicare, Medicaid, and private insurers. We also handle re-attestation cycles and the addition of new providers so that billing stays current and smooth in all places.
Every pulmonology claim that is rejected gets a root-cause review within 24 hours. We appeal with supporting clinical evidence before the payer's deadline passes, whether the rejection is due to a lack of PFT paperwork, a medical necessity argument for a lung treatment, or a bundle change.
The trained coders at our company check out pulmonary function test results, respiratory treatment notes, and procedure paperwork to make sure that the paid CPT codes match the services provided and that no billable part of a lung diagnostic workup is missed.
We handle requests for prior permission for bronchoscopy, lung therapy, sleep study treatments, and any other type of respiratory service that private or Medicaid plans need. To avoid denials after the fact, we keep track of approval dates and end dates.
We handle the whole pulmonology revenue cycle, from making sure the patient is eligible to charge them, post payments, and collect past due amounts. This way, no paid service goes unnoticed for more than 45 days, and no dollar that can be collected is lost early.
Credex Healthcare has the best pulmonology billing in the whole country. Our team stays up to date on all the complicated rules, requirements, and paperwork standards that change constantly based on location, payer, and patient group. We follow all the standard rules, such as Medicare’s Local Coverage Determinations, which are different for each MAC, Medicaid’s prior authorizations that are specific to each state, and the special rules that commercial payers have for advanced pulmonary procedures. Our billing team also keeps up with the changing rules for telehealth billing, so we can get reimbursed quickly and without issues.
Credex Healthcare makes pulmonology bills easier by keeping track of what each state, payer, and service needs. We make sure that your claims are always correct, follow the rules, and are tailored to each payer. This way, you get paid faster and have fewer claims denied. Credex will make sure that your pulmonology payment stays on track.
We apply CMS guidelines and DME MAC LCD requirements for pulmonary function testing, home oxygen, respiratory therapy services, and chronic respiratory disease management, including correct ICD-10 coding for COPD, asthma, and interstitial lung disease diagnoses.
We manage state-specific Medicaid pulmonology billing requirements, including prior authorization mandates for pulmonary rehabilitation and respiratory therapy, covered diagnostic criteria, and managed care organization submission rules that vary across state programs.
We handle prior authorization, benefit verification, and claims submission for pulmonology services with BCBS, Cigna, Aetna, UnitedHealthcare, and regional carriers, applying each payer's current medical-necessity criteria for advanced respiratory diagnostics and procedures.
We bill telehealth respiratory medicine visits with correct place-of-service codes, patient location modifiers, and payer-specific originating site requirements, ensuring your telehealth pulmonology revenue remains compliant and fully collectible under current payer policies.
NPI and credential verification ensure that all pulmonologists and respiratory therapists are signed up with payers and that codes correctly indicate the type of provider and their current enrollment state. By checking that lung function test codes match the tests performed, CPT code review makes sure that the right diagnostic codes are used and that proper documentation is maintained. Paperwork review checks medical records and PFT reports to make sure that billed codes match specific clinical documentation.
Prior authorization tracking keeps an eye on requests for services that need to be approved ahead of time to make sure they are not denied. Payer LCD and coverage compliance review claims and uses medical necessity factors and rules that are specific to the jurisdiction. A/R follow-up keeps track of all pulmonology claims that are still open and escalates those that haven’t been paid within 45 days.
We verify that every rendering pulmonologist and respiratory therapist is individually enrolled and credentialed with the target payer, that taxonomy codes correctly reflect the provider type, and that Medicare and Medicaid enrollment records are current before any claim is submitted.
Our coders confirm that each pulmonary function test CPT code matches the test performed and the tracing documentation present, that inhalation treatment codes are supported by the correct respiratory diagnosis, and that comprehensive PFT codes are applied correctly to avoid unbundling edits.
We audit PFT reports, bronchoscopy procedure notes, respiratory therapy records, and office visit documentation to confirm that billed codes are supported by the clinical record and that ICD-10 codes reflect the maximum available specificity for each respiratory diagnosis.
We handle permission requests for bronchoscopy, EBUS procedures, pulmonary therapy registration, and any other lung service that needs pre-approval. To avoid rejections after the fact, we keep track of the state of approvals and their end dates in relation to the times of procedures.
Before sending in a claim, our team checks it against the MAC's LCD rules for pulmonary function tests and home oxygen, as well as the medical necessity rules for advanced respiratory diagnostics and Medicaid's rules for respiratory therapy services.
AR Follow-Up
All open pulmonology claims are tracked through an organized AR follow-up process that is broken down by payer. If a claim goes more than 45 days without payment or an official payer's decision on an unpaid amount, it is escalated according to set procedures.
The Credex Healthcare billing team makes sure that bills are filled out correctly and sent in on time. Some of the EMRs we use are Epic and Athena Health. They help us follow your payment rules, avoid mistakes, and get paid faster. When we get paid, our team carefully posts and reconciles the money, making sure that all moves are entered properly. Not enough money was paid or rejected is marked so it can be fixed quickly.
Credex Healthcare keeps an eye on all open accounts and follows up on claims that were missed. This helps your team get the money back quickly. We only bring up problems when they need to be, and we’re clear about how follow-ups went. We make the sales cycle process better by using technology and building smart relationships. Those who work in administration will have less worry and cases will be processed more quickly. You’ll get paid faster, and your money will flow more smoothly.
We send pulmonology claims with confirmed CPT codes that match treatment paperwork, correct ICD-10 lung diagnosis codes that are as exact as possible, and any necessary modifiers that are added before electronic transfer to get first-pass acceptance and get rid of avoidable rejections.
Our pulmonology coders look over treatment reports, PFT tracings, and office visit records to make sure that the CPT codes and E&M levels accurately show the level of care and complexity of the services given. This way, you can get full compensation for the clinical work you do.
Management of Prior Authorization
We start and keep track of previous authorizations for bronchoscopy, EBUS, lung therapy, and advanced breathing procedures. We make sure that procedure dates don't conflict with authorization windows and ask for refills before any high-value authorizations are about to expire.
Within 24 hours of being refused, every pulmonology claim is looked at, sorted by what caused the denial, and either fixed and resubmitted or officially challenged with the PFT tracings, bronchoscopy reports, or medical necessity paperwork that the payer needs to overturn the denial.
We credential pulmonologists, sleep medicine physicians, and respiratory therapists with Medicare, Medicaid, and commercial payers, managing recredentialing cycles and new provider enrollment so every clinician in your practice is billing from their first day of patient contact.
Monthly reports cover your clean claim rate by CPT code category, denial breakdown by procedure type and payer, PFT billing compliance metrics, AR aging, and net collections trend, so your practice leadership has the data to make informed revenue cycle decisions.
Years Pulmonology and Respiratory Medicine Revenue Cycle Expertise
Provider Enrollment Coverage for All Active Pulmonology Rosters
HIPAA Compliance Rate Across All Billing Operations
Dedicated Billing Support for Pulmonology Practices
Customized Billing Workflows for Every Pulmonology Practice Model
Pulmonologist
Hassan
“I didn’t know that my PFT claims were being turned down in post-payment checks until Credex showed me the information. Medicare was taking back money they had paid for spirometry tests because our tracing paperwork didn’t always meet their standards for reproducibility. For us, Credex added a PFT paperwork checklist before billing, and after that, the audit recoupments stopped. I wish I had talked about these years earlier because the total amount of publicity was big.”
Pulmonologist and Sleep Medicine Specialist
Menon
“Running both a pulmonology and sleep medicine practice means managing two completely different billing code sets, two sets of prior authorization requirements, and two sets of payer policies simultaneously. My previous billing company could not keep up with either. Credex handles them both with equal competence. Our combined first-pass rate went from 81% to 97%, and our days in AR dropped from 58 to 27 in the first quarter they took over.”
Multi-Physician Pulmonology Group
Jennifer
“We have six pulmonologists and a respiratory therapy unit, and the billing complexity across all those service lines was overwhelming our internal team. Credex took ownership of the whole revenue cycle, making sure the customer was eligible to collect the outstanding balance. Our rejection rate dropped from 19% to less than 5% in 90 days, and we stopped having to write off bronchoscopy claims every month, which was a problem that kept happening. Everyone in the group has noticed the difference in cash flow.”
FQHC Practice
Cruz
“When it comes to billing for pulmonology treatments in a federally qualified health center, things get more complicated than most billing companies can handle. Credex knew how to handle respiratory therapy services not covered by the FQHC rate, and the right way to handle our Medicaid managed care prior-authorization requirements for pulmonary rehabilitation. This is the best our income cycle has ever been.”
Interventional Pulmonologist
Michael
Interventional pulmonology billing, particularly for endobronchial ultrasound and navigational bronchoscopy, is a niche that very few billing companies understand. The rules for prior authorization are strict, the standards for documentation are high, and the claim values are high enough that a single denial is a significant hit to income. From the first month on, Credex got all of our EBUS and robotic bronchoscopy claims right. The change from our old pricing system was clear right away and could be measured.
Practice and Payer Mix Assessment
Assess current CPT code distribution in PFT testing, respiratory therapy, office visits, and procedures. Review denial history by payer and code category, AR aging profile, and any ongoing audits.
Credentialing and Payer Enrollment
Verify credentialing and enrollment for all providers with accurate taxonomy codes. Initiate enrollment for new providers or locations immediately to ensure billing starts on day one.
Documentation and Authorization Workflow Setup
Establish documentation checkpoints for PFT reproducibility, ICD-10 specificity, and prior authorization tracking. Aim to prevent denials through proactive measures.
Clean Claim Submission
Review claims for CPT code accuracy, ICD-10 specificity, modifier completeness, and authorization attachment. Submit claims within 24 to 48 hours post documentation sign-off.
Denial Management and Appeals
Categorize denied claims within 24 hours and prepare responses based on identified deficiencies or disputes, and submit appeals with supporting documentation before payer deadlines.
Reporting & Ongoing Optimization
Provide monthly reports on clean claim rates, denial patterns, and billing compliance metrics. Adjust billing workflows based on data reviews and updates to payer policies or medical-necessity criteria.
Experienced and expert billers and coders at Credex Healthcare know that 94010 and 94726 cannot be billed together on the same date without a modifier that establishes independent medical necessity for each test. Our staff knows how to read a bronchoscopy report and ensure that the CPT codes on the claim are correct and match the operating note. Because we have worked in billing services before, we know how to write a technically sound appeal for a medical necessity rejection on an endobronchial ultrasound claim.
Our billing team is always learning about new PFT CPT code combinations, spirometry reproducibility documentation standards, MAC LCD requirements for home oxygen and respiratory therapy, bronchoscopy procedure billing, and the medical necessity criteria that commercial payers use for advanced pulmonary diagnostics.
You have a named pulmonology billing account manager who knows the types of procedures you do, the contracts you have with payers, and how you handle paperwork. When a commercial payer changes its bronchoscopy coverage policy or a MAC updates its LCD for pulmonary function testing, your account manager lets you know before it shows up in a rejection.
Every month, each client receives a detailed report that includes the number of claims by procedure category, the first-pass acceptance rate, the number of denials by CPT code and payer, PFT compliance metrics, the length of time that an account has been open, and the net collections trend. The numbers are explained in simple terms so that practice leaders can understand their meaning and take action.
At Credex Healthcare, all pulmonology billing is performed in a fully HIPAA-compliant setting that includes encrypted EHR integration, secure electronic claim transmission, and access controls that are enforced across all patient records, procedure reports, and billing data.
Would you like to make more money from your pulmonology practice? Or would you like to improve how you handle your revenue cycle? Credex Healthcare knows a lot about pulmonology billing and coding, and they offer the best pulmonology billing services in the USA so that you can get paid quickly and without any problems.
Credex Healthcare offers pulmonology billing audits for free to eligible companies. The audit checks your use of CPT codes and the accuracy of your E&M level across all of your chronic disease patients, as well as your compliance with PFT documentation, your denial rate by treatment type and payer, your prior authorization tracking workflow, and your current AR aging profile. After the audit, there is no obligation, and most pulmonology practices find at least one important way to recover lost income in the first review session. It is not a question of whether the chance exists. It’s about how ready you are to catch it.
Pulmonology medical billing handles the entire revenue cycle for respiratory medicine, from making sure patients are eligible to sending claims for payment. For bronchoscopy, office visits, pulmonary function tests, nebulizer treatment, and telemedicine visits, you need to be very careful when choosing the CPT codes. What the payer and documentation needs depend on the service. As part of billing services, patients’ insurance coverage is checked, prior permission is requested, claims are denied, payments are posted, and accounts receivable are followed up on.
CPT codes are used for pulmonology billing for office visits, diagnostic tests, treatments, and interventional services. The numbers 94010 for spirometry, 94640 for inhalation, and 94726 for plethysmography are all very common. The codes for EBUS bronchoscopy are 31652 and 31653. Heart therapy codes 93797 and 93798 are part of code 97150, which is for rehabilitation.
To cut down on pulmonology claim rejections, billers need to take important steps. To do this, you need to add three acceptable expiratory movements to the spirometry (94010) PFT documentation and use the right ICD-10 codes, J44.0 or J44, for COPD flare-ups. Add notes to ensure the NCCI bundling rules for PFT codes (94010 and 94726) are followed. Also, check the rules for bronchoscopy and endobronchial prior permission, as they differ.
In 2020, Medicare, Medicaid, and private insurance all paid for online pulmonology services. Traditional Medicare will pay for some virtual office visits using certain codes until 2025, as long as Congress agrees. For pulmonary function tests, you must go in person, but many Medicaid programs give longer coverage with different rules. Commercial payers often match pricing for audio and video while adding rules for audio-only options.
The billing industry is rapidly evolving. By the year 2025, the system and tools used
Billing companies ensure compliance with HIPAA and other regulations by being legitimate and reliable. Every
At Credex Healthcare, we know how frustrating it is when claims are denied. That is
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