Pulmonology practices manage complex billing workflows involving office visits, pulmonary function tests (PFTs), spirometry, bronchoscopy, sleep studies, respiratory treatments, and chronic disease management. Each service has specific coding, documentation, medical necessity, and payer requirements. When claims are not managed accurately, practices can experience preventable denials, underpayments, delayed reimbursement, and growing accounts receivable.
Pulmonary billing also involves technical details that general medical billing teams may overlook. Incorrect PFT component combinations, missing oxygen qualification documentation, bronchoscopy coding errors, and incomplete critical care time records can affect reimbursement.
Choosing an experienced pulmonology medical billing company can help pulmonary practices improve claim accuracy, manage payer requirements, and maintain more consistent revenue cycle operations.
This guide compares seven providers and their publicly described pulmonology billing or broader medical billing services. It distinguishes dedicated pulmonary RCM companies from general billing providers and evaluates the capabilities practices should confirm before outsourcing.
7 Best Pulmonology Medical Billing Companies to Consider in 2027
1. The Medicator’s
Best for: Pulmonary practices seeking broader medical billing and revenue cycle management support.
The Medicator’s provides medical billing and revenue cycle management services for healthcare practices that need support with claims processing, reimbursement workflows, and administrative billing operations.
Its broader service offering may be relevant to pulmonology practices evaluating an external billing partner.
Published services include:
Medical billing and claims management
Revenue cycle management
Accounts receivable management
Insurance eligibility verification
Medical credentialing and provider enrollment
Medical billing audits
Denial management and follow-up
Pulmonary practices should discuss their specific requirements before selecting a service plan. Important areas to confirm include pulmonary function testing, bronchoscopy coding, sleep study billing, oxygen documentation, and critical care claims.
Website: https://themedicators.com/
2. PulmoCare RCM
Best for: Pulmonary and critical care practices seeking a dedicated specialty billing provider.
PulmoCare RCM focuses specifically on pulmonary and critical care revenue cycle management. Its published services address the billing requirements of pulmonary physicians, critical care providers, hospitalists, rehabilitation facilities, and physician groups.
Its published capabilities include:
End-to-end medical billing and RCM
Pulmonary and critical care coding audits
Accounts receivable management
Denial prevention and follow-up
Eligibility and benefit verification
Payment posting and financial reporting
Provider credentialing and payer enrollment
Support for ventilator management and time-based critical care billing
PulmoCare RCM may be worth evaluating for practices with a combination of outpatient pulmonary services and hospital-based critical care work.
Practices should ask for details about its experience with PFT component coding, bronchoscopy procedures, home oxygen documentation, and the specific EHR or hospital systems they use.
Website: https://pulmocarercm.com/
3. Revocare
Best for: Pulmonology practices seeking specialty-focused billing and full revenue cycle support.
Revocare publishes dedicated pulmonology medical billing and coding services. Its specialty offering addresses pulmonary function testing, sleep studies, respiratory treatment billing, and the administrative requirements of pulmonary practices.
Published services include:
Pulmonology-specific medical coding
Pulmonary function test billing
Sleep study billing
Respiratory treatment billing
Patient registration and insurance verification
Charge capture and claim submission
Payment posting and denial management
Revenue cycle reporting and analytics
Revocare may suit pulmonary practices looking for billing support across multiple stages of the revenue cycle rather than claim submission alone.
Before outsourcing, confirm its experience with bronchoscopy coding, oxygen and respiratory equipment documentation, and payer-specific medical necessity requirements.
Website: https://www.revocares.com/specialties/pulmonology
4. Core MB
Best for: Pulmonology practices seeking complete billing, A/R recovery, and credentialing services.
Core MB publishes a dedicated pulmonology medical billing service covering pulmonary function testing, sleep medicine, bronchoscopy, critical care, and chronic management of respiratory conditions.
Its published capabilities include:
Pulmonary function test coding and billing
Bronchoscopy coding and claim review
Sleep testing billing
Insurance eligibility verification
Charge entry and claim scrubbing
Denial management and appeals
Payment posting and reconciliation
Accounts receivable recovery
Provider credentialing and payer enrollment
Core MB also discusses billing considerations for chronic care management and remote patient monitoring for eligible pulmonary patients.
The company may be relevant to independent pulmonologists and pulmonary groups looking for a full-service billing partner. Practices should confirm how its coding team handles individual PFT combinations, procedure documentation, and payer-specific coverage policies.
Website: https://coremb.com/pulmonology-medical-billing/
5. BilNow
Best for: Pulmonology and sleep practices seeking outsourced claims management.
BilNow publishes a dedicated pulmonology billing service covering pulmonary function tests, sleep studies, and bronchoscopy. Its specialty information describes coding from test reports and procedure notes, with attention to National Correct Coding Initiative (NCCI) edits and prior authorization requirements.
Published capabilities include:
Pulmonology and sleep practice billing
Pulmonary function test claim processing
Sleep study billing
Bronchoscopy coding support
Claim scrubbing and submission
Denial management
Payment posting and follow-up
Accounts receivable support
BilNow may be worth considering for smaller pulmonary practices seeking an outsourced billing service with a defined pricing model.
Its website advertises a percentage-based billing rate. Practices should obtain a written quote and confirm which services, coding responsibilities, and additional charges are included before comparing prices with other providers.
Website: https://bilnow.com/specialties/pulmonology-billing/
6. ProMBS
Best for: Pulmonary clinics and physician groups seeking specialty-focused revenue cycle management.
ProMBS publishes pulmonology billing services for pulmonologists, respiratory clinics, physician groups, hospitals, and multi-specialty organizations.
Its published service scope includes:
Insurance eligibility and authorization support
Charge capture and coding review
Claim submission and tracking
Payment posting
Denial management and appeals
Accounts receivable follow-up
Provider credentialing
Revenue cycle reporting
ProMBS describes a workflow that connects patient eligibility, authorization, coding, claims, and payment recovery. This broader approach may suit practices that need help identifying recurring revenue cycle problems rather than addressing individual claim errors.
Pulmonology practices should request specific examples of its work with PFTs, bronchoscopy, oxygen-related claims, and critical care documentation.
Website: https://prombs.com/specialties/pulmonology-billing-services/
7. ClainetRCM
Best for: Pulmonary practices seeking billing, coding, credentialing, and A/R management under one service arrangement.
ClainetRCM publishes pulmonology-specific revenue cycle services for pulmonologists, respiratory clinics, and pulmonary function laboratories.
Its published capabilities include:
Pulmonary function test coding
Bronchoscopy and image-guided procedure coding
Home oxygen and respiratory equipment documentation
Critical care and prolonged service coding
Modifier 26 and TC billing support
Claim submission and payment posting
Denial management and appeals
Credentialing and payer enrollment
Prior authorization and eligibility support
A/R management and revenue cycle audits
ClainetRCM may be relevant to practices that want billing operations combined with coding, credentialing, and administrative support.
Practices should verify the team's experience with their specific pulmonary procedures, confirm the EHR integrations available, and review the proposed pricing and service agreement.
Website: https://clainetrcm.com/specialties/pulmonology-billing
Pulmonology Medical Billing Companies Compared
| Company | Published service focus | Best evaluation area |
|---|---|---|
| The Medicator’s | Medical billing and broader RCM | General practice billing support |
| PulmoCare RCM | Pulmonary and critical care billing | Dedicated pulmonary and ICU workflows |
| Revocare | Pulmonology-specific billing and coding | PFTs and sleep studies |
| Core MB | Pulmonology billing and full RCM | PFTs, bronchoscopy, and A/R |
| BilNow | Pulmonary and sleep practice billing | Claims and procedure coding |
| ProMBS | Pulmonary RCM services | End-to-end revenue cycle support |
| ClainetRCM | Pulmonology billing, coding, and credentialing | PFTs, oxygen, and critical care |
This is an editorial shortlist based on publicly described services, not an independently verified ranking of collection rates, denial performance, or customer satisfaction. The Medicator’s is included based on its broader published medical billing and RCM services; pulmonary practices should confirm its specific specialty capabilities before engagement.
Why Pulmonology Medical Billing Requires Specialty Knowledge
Pulmonology practices provide a combination of diagnostic, procedural, and chronic care services. Each service has different coding and documentation requirements. A billing partner must understand these distinctions to reduce avoidable claim errors.
1. Pulmonary Function Testing and Spirometry
Pulmonary function testing includes several diagnostic procedures, such as spirometry, lung volume measurement, diffusion capacity testing, and pulmonary exercise testing.
Billing teams must identify which tests were actually performed and apply the appropriate code combinations. Reporting components separately when they are already included in a comprehensive service can trigger coding edits and denials.
Medicare coverage also requires medical necessity and appropriate documentation. CMS guidance identifies the need for physician orders, supporting clinical diagnoses, test results, and written interpretations for applicable services.
2. Bronchoscopy and Procedure Coding
Pulmonologists may perform diagnostic and therapeutic bronchoscopies involving biopsy, lavage, navigation, and other procedures.
These services require accurate coding based on the procedure report. Billing teams must review applicable bundling rules, add-on code requirements, and documentation before submitting claims.
Common problems include:
Incorrect primary procedure code selection
Missing documentation for additional procedures
Incorrect add-on code reporting
Inappropriate modifier use
Failure to review applicable NCCI edits
3. Sleep Study Billing
Some pulmonary practices also provide sleep-related diagnostic and treatment services.
Sleep study billing may involve different testing types, professional and technical components, interpretation requirements, and payer coverage policies.
A billing partner should verify the applicable service code, documentation, medical necessity, authorization requirements, and place-of-service rules before submitting the claim.
4. Home Oxygen and Respiratory Equipment Documentation
Pulmonary patients may require oxygen therapy and other respiratory equipment. These services involve documentation and qualification requirements that must be reviewed before claims are submitted.
Billing teams should understand the documentation needed for applicable oxygen coverage, including qualifying test results and supporting medical records. They should also distinguish the physician's professional services from the equipment supplier's billing responsibilities.
5. Critical Care and Time-Based Services
Pulmonologists may provide critical care in hospital and intensive care settings. Certain critical care services are time-based, so documentation must support the total qualifying time and applicable service requirements.
Incomplete time records, inaccurate service reporting, or inappropriate bundling can result in reimbursement problems.
A billing company should review critical care documentation and apply current coding guidance before submitting claims.
What to Look for When Choosing a Pulmonology Billing Company
Before outsourcing your pulmonary practice's billing, evaluate each provider against your service mix, payer requirements, and operational needs.
| Evaluation factor | What to confirm |
|---|---|
| Pulmonology experience | Direct experience with pulmonary practice claims |
| PFT coding | Knowledge of spirometry and testing component rules |
| Bronchoscopy billing | Procedure coding and applicable bundling knowledge |
| Sleep study billing | Testing, interpretation, and payer requirements |
| Oxygen documentation | Understanding of applicable qualification records |
| Critical care coding | Accurate time-based service documentation |
| Prior authorization | Support for services requiring advance approval |
| Denial management | Root-cause analysis and timely appeals |
| A/R follow-up | Aging reports and unresolved claim tracking |
| EHR compatibility | Ability to work with your existing systems |
| Reporting | Regular financial and operational performance reports |
| Pricing and contracts | Transparent fees, scope, and termination terms |
Ask prospective billing companies to explain how they handle a denied pulmonary function test claim or a bronchoscopy claim with multiple reported procedures. Their answers can help you evaluate whether the team understands pulmonary billing beyond routine claim submission.
When Should a Pulmonology Practice Outsource Medical Billing?
Outsourcing may be worth considering when internal billing operations struggle to keep up with pulmonary services, coding requirements, or payer follow-up.
Common signs include:
Increasing pulmonary function test denials
Frequent coding errors involving PFT components
Delayed bronchoscopy reimbursement
Missing oxygen qualification documentation
Sleep study authorization problems
Incomplete critical care time documentation
Growing outstanding accounts receivable
Limited visibility into payer underpayments
High administrative costs for internal billing operations
A qualified billing partner can help establish more consistent claim workflows, improve denial follow-up, and provide better visibility into the practice's financial performance.
Improve Your Pulmonology Practice's Billing and Revenue Cycle
Choosing a pulmonology medical billing company requires more than comparing outsourcing prices. Practices should evaluate pulmonary coding knowledge, PFT billing experience, bronchoscopy procedures, sleep study workflows, oxygen documentation, and denial management capabilities.
The Medicator’s offers medical billing, revenue cycle management, A/R management, eligibility verification, credentialing, and medical billing audit services. Pulmonary practices can discuss their operational requirements and confirm whether the available service scope matches their billing needs.
Looking for medical billing support for your pulmonary practice?
Contact The Medicator’s to discuss your billing requirements and request a practice analysis.
Website: https://themedicators.com/contact/
Phone: (888) 277-1460
Email: info@themedicators.com
Frequently Asked Questions
1. What is pulmonology medical billing?
Pulmonology medical billing involves coding and submitting claims for pulmonary services, including office visits, spirometry, pulmonary function tests, bronchoscopy, sleep studies, respiratory treatments, and other respiratory care services.
2. Why should pulmonary practices use a specialized medical billing company?
A billing company familiar with pulmonology can help manage PFT coding, bronchoscopy claims, sleep study requirements, oxygen documentation, critical care services, and payer-specific billing rules. This can reduce administrative pressure and improve billing oversight.
3. What causes pulmonary function test billing denials?
Common causes include incorrect code combinations, missing physician orders, insufficient medical necessity documentation, incomplete test reports, and payer coverage restrictions. Reviewing the applicable payer policy and supporting clinical documentation can help prevent recurring denials.
4. How is bronchoscopy billed?
Bronchoscopy is billed using procedure-specific CPT codes selected according to the services documented in the procedure report. The coding process must account for applicable bundling rules, additional procedures, and documentation requirements.
5. Do pulmonology billing companies handle oxygen and respiratory equipment claims?
Some providers offer support for oxygen-related documentation and respiratory equipment billing workflows. Practices should clarify whether the billing company handles physician services, equipment supplier claims, or both, since these can involve different billing responsibilities.
6. Can a medical billing company manage sleep study claims?
Yes. Providers offering sleep-related billing support may manage coding, claim submission, documentation review, and payer follow-up. Practices should confirm experience with their specific sleep testing services and payer authorization requirements.
7. How do I choose the best pulmonology medical billing company?
Compare pulmonary specialty experience, PFT and bronchoscopy coding knowledge, sleep study billing, oxygen documentation, critical care coding, denial management, A/R follow-up, EHR compatibility, pricing, and reporting capabilities.
