What we handle for rheumatology practices
Billers are assigned by specialty, so the person working your claims already knows your codes and your payers.
Biologic infusions
Infusion administration and J-codes billed to documented time and units.
Joint injections
Large and small joint injections billed with correct site, laterality and any ultrasound guidance.
In-office laboratory
Covered laboratory testing billed within CLIA scope and payer policy.
Authorisation and step therapy
Approvals tracked per drug, including step-therapy requirements before a biologic is approved.
Where rheumatology claims usually go wrong
These are the four issues we see most often when we take over a rheumatology practice.
Step therapy requirements
Many payers require documented failure of a cheaper drug first. Skipping that step means the biologic is denied entirely.
Infusion time documentation
Administration codes depend on documented start and stop times, not the appointment length.
Ultrasound-guided injections
Guidance is separately payable with a saved image and documentation. Without both it is not.
Buy-and-bill cash flow
Drugs purchased before authorisation is confirmed become uncompensated inventory.
How we work
Eligibility, every day
Every next-day scheduled patient is verified for active coverage before the visit.
Charges validated
Codes and documentation are checked after the note is signed, before the claim is submitted.
Denials appealed
Every denial is reviewed, corrected and resubmitted. Nothing is written off by default.
Monthly reporting
Paid claims and AR aging reports so you can see exactly where your money is.
Rheumatology billing questions
Something not covered here? Call (833) 305-5528.
Do you track step therapy?
Yes. We flag what the payer requires before the biologic will be approved.
Can you bill in-office infusion?
Yes, including administration time and drug units.
Do you handle joint injection billing?
Yes, including guidance when documented.