Rheumatology Billing Services That Boost Collections and Cut Denials by 40%

Our AI-assisted claim review and team of certified billing experts help rheumatology practices achieve 95%+ first-pass claim rates and recover up to 20% in lost revenue from documentation and coding errors, as proven by CMS-backed performance metrics.

Facing High Infusion Denials, Revenue Leaks and Payment Delays?

Rheumatologists encounter billing challenges, including complex coding for autoimmune conditions, managing infusion therapies, and navigating insurance requirements. These challenges often delay reimbursements and inflate denial rates.
Our specialized rheumatology billing services simplify your revenue cycle, improve collections, and assure compliance, allowing you to focus on what matters most.

Rheumatology Medical Billing Services

We offer a full range of Rheumatology Medical Billing solutions to prevent denials, reduce delays, and maximize collections:

Eligibility and Benefits Verification

Verify the patient's insurance coverage, copay, and prior authorizations to avoid eligibility-related denials

Claims Scrubbing and Submission

Detecting and correcting coding or modifier errors before submission for a 95%+ first-pass rate.

Prior Authorization and Referral Management

Smoothly handle all pre-approvals and referrals for infusions and injections.

Accurate Coding and Charge Entry

Provide explicit CPT, ICD-10, and HCPCS coding for autoimmune and arthritis treatments.

Accounts Receivable (A/R) Follow-Up

Reduce aging claims to 20–30 days through active monitoring.

Denial Management and Appeals

Identify, correct, and appeal denied claims to recover lost revenue efficiently.

Payment Posting and Reconciliation

Record and verify all payments to ensure accurate reimbursement and cash flow.

Compliance and Audit Support

Maintain HIPAA, ACR, and Medicare compliance with secure, audit-ready documentation.

Infusion and Biologic Drug Billing

Expert handling of Remicade, Actemra, Orencia, and similar therapies with J-code accuracy.

Financial Reporting and Analytics

Transparent reports for revenue insights and trends.

Rheumatology Sub-Specialties
We Support

We specialize in billing across all rheumatology subspecialties:

Our Core Services Include:

Pediatric Rheumatology

Billing for juvenile arthritis, lupus, and developmental care.

Adult Rheumatology

Accurate claims for RA, OA, and autoimmune conditions.

Infusion & Biologic Therapy

Full support for Remicade, Orencia, Actemra, and J-codes.

Immunology & Autoimmune Care

Precise coding for complex immune disorders.

Pain Management in Rheumatology

Correct billing for injections, joint procedures, and therapies.

Osteoporosis & Metabolic Bone Disease

DXA scans, labs, and treatment documentation.

Tele-Rheumatology Services

Remote care claims, E/M coding, and compliance tracking.

HIPAA-Compliant and Transparent Operations

We comply with HIPAA, CMS, and ACR standards. Our secure billing systems protect PHI with encryption and controlled access, giving your staff real-time visibility into claims, adjustments, and reimbursements for complete transparency.

Common Rheumatology Medical Billing Errors

Billing Challenge

Time-Based Errors

(incorrect infusion times, prolonged service misuse)

Usage-Based Errors (incorrectly

biologic quantities, wastage documentation)

Feature-Based Errors

missing modifiers 25/59/JW, outdated CPT/ICD-10 codes

Documentation Gaps

(incomplete charts for injections/infusions)

Prior Authorization Issues

(delayed or missing approvals)

Staffing Shortages / Training Gaps

Impact on Practice

Claim denials, compliance issues, and delayed payments

Lost revenue, underpayments

Partial payments, rejected claims

Increased denials, audit risks

Payment delays, denied claims

Errors, delayed billing, and low collections

Our Solution

Accurate tracking of infusion times and correct CPT application

Verification of drug dosage, NDC linkage, and wastage modifiers

Updated 2025 CPT/ICD-10 compliance and correct modifier application

Certified coders review charts against ACR and CMS standards

Full management of pre-approvals and payer follow-ups

Dedicated rheumatology billing specialists and continuous staff training

Value-Based Care in Rheumatology Billing

With the shift toward value-based reimbursement, both rheumatology and internal medicine billing require rigorous documentation of outcomes to avoid penalties and maximize incentive bonuses. We help you turn compliance pressure into financial opportunity:

Here’s how we support your success under value-based care:

We enable:

MIPS and Quality Reporting Support: We handle complex MIPS submissions, ensuring accurate and timely reporting to prevent penalties and qualify for performance bonuses.
Risk Adjustment and Outcome Tracking: Our analytics tools help you monitor patient outcomes and identify care gaps that impact reimbursement scores.
Compliance with CMS 2025 Guidelines: Stay protected from audit risks with proactive adherence to the latest value-based documentation and coding updates.
Bonus-Driven Reimbursements: We align your billing with high-value care indicators to improve your performance scores and maximize incentive payments.

Key Components of Rheumatology Billing at Dastifty Solutions

Procedure	Procedure Description	Critical Modifiers
99214	Established patient office visit (moderate complexity)	-25, -24
20610	Arthrocentesis, aspiration, and injection of a major joint (e.g., shoulder, knee)	-RT, -LT, -50
96401	Chemotherapy administration, subcutaneous or intramuscular (non-IV push)	-59, -76
85652	Erythrocyte sedimentation rate (ESR) test	-QW
364151	Venipuncture for the collection of venous blood	-59
J1030	Injection, methylprednisolone acetate (40 mg)	-RT, -LT
77080	Dual-energy X-ray absorptiometry (DXA), axial skeleton	-26, -TC
99204	New patient office visit (moderate complexity)	3-25, -57
J1200	Injection, diphenhydramine hydrochloride, up to 50 mg	-59, -76
J0702	Injection, betamethasone, per 3 mg	-RT, -LT

FAQs on Rheumatology Billing

What are common billing challenges in rheumatology?

Complex CPT/ICD-10 codes, infusion billing, and high denial rates. Accurate documentation and prior authorizations minimize errors.

How do I bill for biologic infusions like Remicade or Actemra?

Use the right J-codes, track dosage, apply modifier -JW, and complete prior authorization before submission.

Which CPT codes apply to infusion services?

Which CPT codes apply to infusion services? Codes such as 96401 (subcutaneous/intramuscular therapy) and 20610 (joint injection) are frequently used.

How can I avoid infusion therapy denials?

We verify eligibility, use correct modifiers (25/59), maintain E/M documentation, and confirm prior authorizations.

Does Medicare cover biologic therapy for arthritis?

Yes, when medical necessity, CPT/ICD-10 accuracy, and authorization are correctly documented.

Ready to Reduce Denials and Increase Collections by 20%?

With 500+ certified billing specialists experienced in rheumatology and infusion billing, we help practices nationwide reduce denials, accelerate collections, and stay fully compliant.