The Pulmonology Revenue Reality
Pulmonology is diagnostic-intensive and Medicare-sensitive. Small coding or documentation inconsistencies can result in repeated denials.
- Pulmonary function test (PFT) bundling errors
- Bronchoscopy modifier misuse
- Sleep study authorization gaps
- Oxygen-related documentation deficiencies
- Medical necessity denials
- E/M downcoding for complex cases
- Chronic Care Management (CCM) underutilization
- High-dollar AR tied to procedures
Diagnostic & Procedural Coding Precision (CCP)
- PFT bundling logic
- Bronchoscopy modifier governance
- Add-on code integrity checks
- Documentation-to-procedure alignment
- E/M complexity validation
Target Outcome: Reduced diagnostic and procedural denials.
Authorization & Coverage Controls (FIO + EAE)
- Sleep study authorization validation
- Coverage confirmation for advanced diagnostics
- Frequency monitoring
- Diagnosis-to-test alignment
Target Outcome: Fewer authorization-related disruptions.
Chronic Care & AR Optimization (AAF)
- Structured follow-up on aging balances
- Payer-specific denial appeal workflows
- Chronic-care denial management
- AR > 90 monitoring by CPT category
Target Outcome: Faster reimbursement and improved cash flow consistency.
Respiratory Reimbursement Intelligence (PRL)
- PFT denial clustering
- Bronchoscopy underpayment trends
- Sleep study reimbursement variance
- E/M downcoding patterns
- AR aging concentration by payer
Target Outcome: Visibility into recurring respiratory revenue leakage.
Measurable Performance Targets
- 8–18% lift in net collections
- 15–30% reduction in diagnostic and procedural denials
- 25–40% reduction in AR > 90
- 95–98% first-pass claim acceptance
- Improved chronic-care capture consistency
Compliance & Infrastructure
- HIPAA-compliant workflows with BAA signed prior to PHI exchange
- Integration with major EHR platforms including Epic, Cerner, Athenahealth, NextGen, eClinicalWorks and others
- Cybersecurity oversight via Redfort Technologies
- U.S.-based nationwide operations
Are Your PFT, Bronchoscopy, and Sleep Study Claims Being Fully Reimbursed?
Schedule a specialized Pulmonology Revenue Audit and identify how coding accuracy, documentation gaps, and denial patterns are affecting your claims, AR performance, and net collections.
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