By Lemuel Areglo, CPC | Director of Revenue Cycle Management Services
Key Takeaways
- Disconnected clinical and billing workflows are a prevalent source of claim errors and denials in pulmonology practices.
- Denied claims lose most of their value after 90 days, making timely follow-up one of the most effective habits in your revenue cycle.
- Staff turnover can significantly impact billing accuracy, as specialized knowledge in pulmonology coding is often not documented.
- You cannot address issues that you do not monitor. Regular reviews of denial rates and accounts receivable aging help catch problems before they impact cash flow.
If your collections fluctuate dramatically from month to month, you are not alone. This inconsistency is common among pulmonology practices and rarely stems from a single issue.
Most revenue instability arises from a combination of minor operational challenges that accumulate over time. The encouraging news is that once you identify the factors contributing to this inconsistency, many can be addressed effectively.
Table of Contents
Your EHR and Billing System May Not Be Aligned
Pulmonology billing is intricate. You deal with procedure codes for pulmonary function tests, sleep studies, and chronic respiratory disease management, along with modifier requirements and payer-specific documentation standards that vary by carrier.
When your clinical documentation and billing processes are not integrated, manual data transfer becomes necessary. This handoff is where errors occur—missed modifiers, incorrect procedure codes, or documentation gaps that do not support the billed service level. Each of these can lead to denials or underpayments.
The Medical Group Management Association has found that practices with integrated clinical and billing systems experience lower denial rates and faster payment cycles than those operating with disconnected platforms. For pulmonology practices managing a high volume of procedural claims, this difference can be substantial.
Timely Denial Management: A Key to Financial Stability
Every pulmonology practice encounters claim denials. The critical question is whether your team has a systematic process for following up on these denials or if they are left unresolved while new work takes precedence.
Industry data indicates that after 120 days, providers typically recover only about 10 cents on the dollar. Collection rates drop sharply after 90 days, meaning a denial from three months ago is not just an inconvenience; it represents mostly lost revenue.
Practices that manage this effectively tend to have a structured denial workflow: denials are reviewed within a set timeframe, prioritized by dollar amount and payer, and tracked through to resolution. Without this structure, your monthly collections may fluctuate based on how much capacity your billing staff has to follow up that week.
Staff Turnover Disrupts More Than Morale
Pulmonology billing knowledge is specialized. Your experienced billers understand which payers frequently reject certain modifiers, how to document medical necessity for pulmonary function tests, and when to appeal versus refile. This knowledge is often not documented and resides with your staff.
When a biller leaves, that institutional knowledge departs as well. New staff may make mistakes that take time to surface, and training can take weeks. During this period, coding inconsistencies may increase, leading to higher denial rates.
This challenge is difficult to address, but building resilience into your billing operation is worthwhile. Cross-training, documented workflows, and clear coding guidelines for your most common pulmonology procedures can help mitigate the impact of turnover.
If You Cannot See the Problem, You Cannot Fix It
Many practices lack easy access to the metrics that indicate collection issues early on. Days in accounts receivable, first-pass claim acceptance rates, denial rates by payer, and aging accounts by provider are crucial indicators. Without this visibility, problems can escalate unnoticed.
A spike in denials from a specific commercial payer might go undetected for a month. An accounts receivable bucket aging past 90 days may not be flagged until it is close to uncollectible. Without regular reporting on these indicators, your revenue cycle management becomes reactive.
Practices that consistently review these metrics, even with a brief weekly assessment of denial trends and accounts receivable aging, are better positioned to identify problems early and correct them before they impact cash flow. Advanced Pulmonology-specific EHRs have Business Intelligence dashboards embedded into their EHR, providing intelligent data visualizations of your practice’s billing performance. Utilizing this feature is the first step to identifying trends and potential issues.
Coding Errors Are More Common Than Most Practices Realize
Some estimates suggest that a significant portion of medical claims contain errors, many of which occur before the claim reaches the payer. In pulmonology, common coding issues include missing or incorrect modifiers for procedures, place-of-service errors on in-office versus facility claims, and documentation that does not support the diagnosis or complexity level billed.
These errors do not always result in outright denials; some lead to underpayments that go unnoticed, while others may trigger audits. Establishing consistency in your coding process, whether through a billing rules engine, specialty-trained billers, or regular coding audits, can help reduce this variability.
Patient Balances Deserve the Same Attention as Insurance Claims
High-deductible health plans have shifted more payment responsibility to patients. For pulmonology practices that perform procedures, patient balances can be significant.
Collecting that revenue requires clear communication before the appointment about what the patient will owe, accurate estimates at the time of service, and convenient payment options. Practices that automate balance reminders and offer multiple payment methods tend to collect more patient revenue with less staff effort. Those that do not often find patient accounts receivable aging quickly, with limited recourse once the balance is several months old.
Scheduling, Clinical, and Billing Teams Often Operate in Silos
In many pulmonology practices, information is exchanged between teams through verbal handoffs, paper notes, or separate systems that do not synchronize. An insurance eligibility issue might not arise until after services are rendered. A prior authorization for a procedure might expire because no one flagged it in time. A clinical note may not reach the billing team before the filing deadline.
Each of these gaps can lead to claims that are delayed, denied, or written off. Improving communication between your scheduling, clinical, and billing teams—whether through technology or clearer internal processes—can significantly reduce this type of revenue leakage.
What to Do With This Information
If any of these challenges resonate with you, the next step is to identify which are most affecting your practice. Pull your denial reports for the last 90 days, review your accounts receivable aging by bucket, and consult with your billing staff about where claims tend to get stuck.
You do not need to tackle everything at once. Addressing the highest-impact issues first—whether that is denial follow-up, coding accuracy, or documentation gaps—will yield measurable improvements in your collections over time.
Frequently Asked Questions
What is the most common reason Pulmonology practices see inconsistent collections?
Disconnected clinical and billing workflows are a common issue. When documentation does not flow directly into claim submission, manual data transfer introduces errors that can affect multiple claims. Delays in denial follow-up exacerbate the problem over time.
How quickly do unpaid claims become uncollectible?
Collection rates significantly decline after 90 days. By 120 days, most practices recover only a small fraction of what is owed. Timely follow-up on denials and aging accounts is one of the most effective activities in revenue cycle management.
Why is Pulmonology billing more challenging than primary care billing?
Pulmonology involves a high volume of procedural claims, bilateral procedure modifiers, and payer-specific documentation requirements that vary by carrier. Coding errors that might go unnoticed in a primary care setting are more likely to result in denials or underpayments in a specialty context.
What metrics should Pulmonology practice managers monitor regularly?
Days in accounts receivable, first-pass claim acceptance rate, denial rate by payer, and accounts receivable aging by bucket are the most useful starting points. These four indicators will reveal most collection problems before they escalate.
When does it make sense to consider outsourced billing?
If staff turnover is frequent, denial follow-up is consistently delayed, or your team lacks pulmonology-specific coding expertise, a specialty-focused billing service may yield more stable results than maintaining an in-house operation.
Want to see where your clinic stands? A baseline RCM assessment is the first step.
Lemuel Areglo, CPC
is the Director of Revenue Cycle Management Services at WRS Health, bringing nearly 15 years of experience leading medical billing, coding, credentialing, and revenue cycle operations across the healthcare industry. Lemuel’s expertise spans the full revenue cycle, including claims management, denial resolution, payment posting, accounts receivable, and practice operations. He has extensive experience supporting specialties including pulmonology, psychiatry, physical therapy, pain management, internal medicine, orthopedic surgery, speech therapy, and sleep medicine.
