Services · Denial management & appeals
“We handle denials” is not an answer
Most pulmonology denials trace back to a handful of causes, and most are preventable. Real denial management appeals what's appealable, fixes what's fixable, and changes the upstream process so the same denial doesn't return next month. Here's how to tell who actually does that.
Compare free quotesThe usual suspects
Where pulmonology denials actually come from
Missing PFT interpretation. The technical work was done, but the signed physician interpretation wasn't in the record at billing. Routinely denied, routinely preventable.
Bronchoscopy bundling. Multi-procedure sessions billed against NCCI edits without the right modifier, or bundled work that deserved a documented appeal.
Component confusion. Global billing where only the professional component (26) was yours, or vice versa. Endemic wherever hospital equipment meets private-practice physicians.
Authorization gaps. The study happened; the approval didn't.
Medical necessity. The diagnosis code didn't support the test under the payer's policy, even though the clinical picture did. A documentation translation problem, not a clinical one.
What to demand from denial management
Same-day categorization of every denial. Appeals that cite the payer's own policy with documentation attached — not blind resubmission. Root-cause tags on non-appealable losses. And a monthly pattern report: which payers, which codes, which causes, and what changed upstream so the category shrinks.
Ask any bidder: “show me an example appeal letter and your denial-category report.” Both exist if the work is real.
Denial management, answered
What denial rate should a pulmonology practice expect?
Denial rates vary by payer mix and service line, and quoted industry averages are unreliable marketing. The better metric to demand: what percentage of denials get worked within 48 hours, and what share of appeals succeed.
Is resubmitting a corrected claim the same as an appeal?
No. Correcting and resubmitting fixes clerical rejections. An appeal argues coverage or bundling with evidence. A biller who conflates the two will write off what should have been fought.
Make them show their work
Get competitive quotes, then ask each biller for a sample appeal letter and a denial-category report.
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Takes 30 seconds. Free for practices. No obligation.
Free for practices. No obligation.