Pulmonology / Sleep Medicine Billing

Hard-billed Revenue Cycle Management for Respiratory and Sleep Disorder Practices

Summary – Where Does Accurate Billing Belong in Pulmonology and Sleep Medicine?

Pulmonology and Sleep Medicine are two related specialties that deal with life-altering illnesses to the lungs, respiratory system, and sleep medicine. These fields—be they in the diagnosis of chronic obstructive pulmonary disease (COPD), bronchoscopies, or the interpretation of complicated sleep study data—are purely procedure-intensive and documentation-based.

Although optimal patient outcomes remain the highest priority, you can provide billing that is accurate, billing-compliant, and efficient to ensure and maintain the financial stability of your practice. Regrettably, pulmonology and sleep medicine billing is one of the hardest niches in the fields of medical billing because of:

  • Multifaceted diagnosis and procedural coding with several CPT codes as well as ICD-10 codes per patient case.
  • Stringent stipulated laws regarding payer compliance, particularly for Medicare and Medicaid schemes.
  • Development of aspects of bundle payments on a group of respiratory and sleep services.
  • Constant supply claim and CPAP/BiPAP complex DME bills.
  • Mandatory norms of testing and treatment with usual pre-authorizations.

NexCure LLC offers end-to-end specialty-specific billing solutions, allowing pulmonologists, respiratory therapists, and sleep medicine specialists to ensure maximum reimbursements, lower denials, and maintain compliance.

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    The Reason Pulmonology & Sleep Medicine
    Billing Requires Specialized Skill

    By contrast, pulmonology and sleep medicine require coders and billers to be extensively familiar with, Lack of expertise can cause billing errors to be rejected, delayed, or result in compliance audits.

    Pulmonary Function Test (PFT) Billing

    Such as spirometry (94010), lung volumes, diffusion capacity (DLCO), and bronchoprovocation testing.

    High-Complex Diagnostic Coding

    Including bronchoscopes, thoracentesis, biopsy of the pleura, or assistance with mechanical intubation.

    Polysomnography (Sleep Study Billing)

    CPT 95810 (full-night study), 95811 (split-night CPAP titration), 95800–95806 (home sleep apnea testing).

    Global vs. Split Billing

    Separation of technical and professional components when required.

    Durable Medical Equipment (DME) Billing

    HCPCS billing codes for CPAP/BiPAP machines, masks, tubing, humidifiers, and filters.

    Usage of Modifiers

    Such as 26 (professional component), TC (technical component), 59 (distinct procedural service), and KX (medical necessity met).

    Why NexCure LLC?

    NexCure LLC – Pulmonology & Sleep Medicine Billing Process

    We are an organized system that aims to be precise, compliant and make swift payments:

    • Always check insurance, deductible, and co-pay.
    • Obtain pre-authorizations for sleep studies, pulmonary tests, and DME.
    • AAPC-certified coders specialized in pulmonology CPT and ICD-10 sleep disorders.
    • Correct application of modifiers to maximize reimbursement.
    • Proper coding for split-night & full-night studies.
    • Support repeat CPAP/BiPAP rentals, purchases, and supplies.
    • Track compliance requirements (e.g., 4 hours/night, 70% of nights for Medicare).
    • Pre-submission review to eliminate errors before rejections.
    • E-filing for prompt turnaround.
    • Settlement posting via Explanation of Benefits (EOBs).
    • Identify underpayments and initiate recovery.
    • Recognize recurring rejection patterns.
    • Monitor payer trends to prevent repeated issues.
    • Understand CMS, Medicare, and commercial payer requirements.
    • Maintain documentation for payer audits.
    • Monthly revenue and denial analysis.
    • Identify ways to improve collections and reduce A/R days.
    Typical Problems and Challenges

    Billing in Pulmonology & Sleep Medicine

    Motives – Sleep Studies

    • Medical necessity denials (e.g., insufficient proof of excessive daytime sleepiness or potential sleep apnea).
    • Lack of prior authorization for facility-based sleep studies.
    • Duplicate codes and bundled payments.

    Bundled Respiratory Processes

  • Inappropriate billing may lead to underpayment.

    • Complex Billing Policy for DME

  • CPAP rentals transitioning to purchases after a fixed rental period—failure to track correctly leads to rejections.

    • Single-Payer vs. Multi-Payer Compliance Differences

    • Medicare does not have the same documentation requirements as commercial insurers.
    • Medicaid may have state-specific billing regulations.

    Post-Care Billing Issues

  • Billing aftercare when the cost is already covered in the initial service payment.

    • Why Partner with NexCure LLC for Endocrinology Billing?

    When you need endocrinology billing services, NexCure LLC will help you see more patients
    while we manage the complexities of endocrinology billing

    Specialty Qualifications

    30+ years of combined respiratory/sleep billing experience.

    98%+ Clean Claim Rate

    fewer payment delays and denials.

    HIPAA-Compliant Operations

    Secure handling of PHI and financial data.

    Open Communication

    Real-time claim tracking and reporting.

    Proactive Revenue Optimization

    Identifying missed reimbursement opportunities.

    Partner with NexCure LLC to Simplify Your Billing

    Practices in pulmonology and sleep medicine have specialized billing issues that go beyond general billing knowledge. NexCure LLC manages your billing to ensure claims are paid efficiently, with minimal compliance risk allowing your staff to focus on patient care.

    Contact us today to schedule a consultation. We will show you how our targeted billing services can reduce overhead, increase revenue, and save your administrative staff valuable time.

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      Client Testimonials

      What Healthcare Providers Say About Us

      "Working with NexCure LLC has been a relief for my clinic. They took care of my credentialing process from start to finish, no delays, no confusion. I also like how they keep up with CMS quality programs and explain things clearly. Honestly, they’ve made my life much easier."

      Dr. Ayesha Rahman, MBBS

      "Before NexCure LLC, our billing was a nightmare — denials, delays, you name it. Their team stepped in and fixed our revenue cycle quickly. What I appreciate most is their guidance on MIPS reporting; they walked my staff through the requirements and we’ve already seen the results. Dependable and professional."

      Dr. James Whitman, MD

      "The attention to detail at NexCure LLC is impressive. They helped us get credentialed with several payers and made sure everything stayed compliant. Their support with HEDIS reporting boosted our scores, which directly benefited our contracts. I’m grateful for their hard work."

      Dr. Maria Gonzalez, MD

      "I’ve been very satisfied with the services from NexCure LLC. They keep me updated on payer rules and compliance, which is something many billing companies overlook. My billing cycle is smoother now, and their assistance with MIPS reporting has been a real plus. It feels like they are part of my team."

      Dr. Omar Al-Farouq, MD

      "Our practice needed someone who really understood billing and coding. NexCure LLC improved our collections and made the whole process less stressful. They’re straightforward, easy to reach, and they actually deliver on what they promise. I recommend them without hesitation."

      Dr. Alejandro Ramirez, DO
      12+

      Years of Expertise in Medical Billing & Revenue Cycle Management

      85+

      Providers Across Multiple Specialties Trust NexCure LLC Consultancy

      97%

      Clean Claims Rate Achieved on First Submission of Project Delivery

      15K+

      Claims Accurately Processed Every Month

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      (929) 587-3833

      Email address:

      Info@nexcurellc.com

      1500 N Grant ST #5001, DENVER, CO, 80203

      United States

      WhatsApp:

      (929) 587-3833

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