Billing for rheumatology is not general billing with a different code set. Biologic infusion coding by NDC and units alongside administration hierarchy, where a units error is immediately expensive.
Specialty-drug authorization and step therapy gate most treatment, and buy-and-bill economics mean a denial costs the drug as well as the fee.
At a glance
What drives the coding
Biologic infusion coding by NDC and units alongside administration hierarchy, where a units error is immediately expensive.
What drives the payer behavior
Specialty-drug authorization and step therapy gate most treatment, and buy-and-bill economics mean a denial costs the drug as well as the fee.
Coding
Assigned by certified coders from your documentation.
Reporting
Denials segmented by reason, payer, and provider.
Where rheumatology claims actually fail
- Step therapy not documented before the biologic
- Drug units miscalculated against the NDC
- Infusion hierarchy billed out of order
How we work it
We code from what your record documents and query you when it does not support a code, which in rheumatology is where most of the avoidable exposure sits.
Denials are worked by cause rather than in queue order, so the same failure stops recurring instead of being re-worked every month.
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your current rheumatology denials and aging.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes reported monthly, segmented by payer.
Rheumatology — Frequently Asked Questions
Do you have coders who know rheumatology?
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Yes. All coding is performed by certified coders, and specialty assignment is deliberate — biologic infusion coding by NDC and units alongside administration hierarchy, where a units error is immediately expensive.
Do you guarantee we will collect more?
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No, and nobody honestly can. Payment is decided by the payer. What we commit to is the process and the six numbers we report, which you can check against your own system.
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