Pulmonology Revenue Cycle Management

Built for the complexity
of respiratory care revenue.

Clientele's pulmonology intelligence platform validates PFT bundling, sleep study CPT logic, bronchoscopy coding, and DME/HCPCS claims, so every respiratory encounter reaches the payer clean, from consultation to CPAP compliance.

HIPAA Compliant
SOC 2 Type II
Patient
Consultation
Pulmonary Function Test
Sleep Study
Bronchoscopy
Documentation
Claim Validation
Insurance Approval
Revenue
The Ecosystem

Respiratory care touches more billing
systems than any other specialty.

Ten clinical domains feed into a single revenue outcome.

Pulmonology Revenue Intelligence

Sleep Medicine

Sleep study CPT codes depend on study type and titration data.

In-lab vs. home sleep test coding is a frequent source of denials.

Pulmonary Function Tests

PFT bundling rules shift based on which tests run together.

Incorrect PFT bundling is one of the most common pulmonology denials.

Bronchoscopy

Procedure codes vary by technique, biopsy type, and fluoroscopy use.

Bronchoscopy claims with biopsies require precise add-on code pairing.

COPD

Chronic care management codes require ongoing documentation.

COPD chronic care claims are frequently under-coded for complexity.

Asthma

Severity classification drives both treatment and billing codes.

Asthma severity documentation gaps are a common audit finding.

Critical Care

Time-based critical care codes require precise documentation.

Critical care time documentation is a top source of billing disputes.

Respiratory Failure

Acute vs. chronic respiratory failure codes affect reimbursement significantly.

Miscoding acute vs. chronic failure changes payment substantially.

Oxygen Therapy

Certificate of medical necessity requirements vary by payer.

Missing CMN documentation is a leading cause of oxygen therapy denials.

CPAP

Compliance data must be on file before ongoing claims are paid.

CPAP compliance gaps are the top reason for DME claim denials.

DME

HCPCS codes and modifiers must match the specific device supplied.

DME HCPCS mismatches are a leading cause of equipment denials.
The Journey

The complete respiratory patient journey.

Referral
Diagnosis and payer eligibility confirmed
Consultation
History and symptom severity documented
PFT
Spirometry coded per bundling rules
Imaging
Chest imaging linked to the diagnosis
Sleep Lab
In-lab or home study coded by type
Procedure
Bronchoscopy coded with modifiers
Documentation
Chart supports every code billed
Claim Scrubbing
Payer rules and HCPCS checked
Payment
Remittance posted, denials routed
The Platform

Pulmonary Coding Intelligence

Seven modules validate every respiratory claim before it ever reaches a payer.

PFT Validation

Validated

Confirms spirometry and lung volume tests follow current bundling rules.

98.7%
bundling accuracy

Bronchoscopy Coding

Active

Matches technique, biopsy type, and fluoroscopy use to the correct code set.

410
procedures reviewed

Sleep Study CPT

Synced

Applies the correct CPT set based on study type and titration data.

In-Lab + Home
study logic covered

HCPCS Validation

Validated

Confirms HCPCS codes and modifiers match the device supplied.

DME
+ CPAP code match

Modifier Intelligence

Active

Flags missing or mismatched modifiers before submission.

1,120
modifier checks

Medical Necessity

Validated

Confirms documentation supports every code billed.

Matched
diagnosis-to-code

Documentation Score

Processing

Scores chart completeness against payer documentation requirements.

96%
first-pass rate
Sleep Medicine + DME Intelligence

Live analytics across sleep, DME, and compliance.

Live

Sleep Studies

Tracks in-lab and home sleep study results as they're scored.

24 pending

CPAP Orders

Monitors CPAP orders from prescription through delivery.

Active

DME Tracking

Tracks durable equipment orders and delivery confirmation.

Synced

HCPCS

Keeps HCPCS codes current against payer-specific bulletins.

89% approved

Prior Authorization

Monitors sleep study and DME authorization status by payer.

92% on file

Compliance

Confirms CPAP usage data is on file before ongoing claims bill.

Updated daily

Claim Status

Shows real-time status across every pulmonology and DME claim.

$1.8M tracked

Revenue

Projects reimbursement across sleep, DME, and procedure lines.

Clientele AI

One continuous line of defense, breath to remittance.

Clinical Documentation

Captures every pulmonary encounter detail needed for clean coding.

AI Review

Cross-checks documentation against payer and coding rules in real time.

CPT Recommendation

Surfaces the correct PFT, bronchoscopy, or sleep study CPT set.

HCPCS Validation

Confirms DME and CPAP HCPCS codes match the device and modifier.

Medical Necessity Check

Validates diagnosis and severity support every code billed.

Claim Scrubbing

Runs a final payer-specific check before a claim ever leaves the building.

Denial Prevention

Flags high-risk claims and missing documentation before submission.

Revenue Optimization

Identifies underpaid claims and coding opportunities across your payer mix.

Revenue Performance

Directional results our practices see.

0%
Clean Claim Rate
Consistently high across payers
0%
Sleep Study Success
Improved first-pass reimbursement
40% Faster
DME Turnaround
Than manual processing
0%
Bronchoscopy Accuracy
Procedure-to-code match
+22%
Chronic Care Capture
More CCM visits captured
0%
Collection Performance
Of billed revenue collected
Pulmonology Ecosystem

One platform, every respiratory service line.

Select a specialty to see how Clientele handles its billing workflow.

Pulmonology
Service Line

Sleep Medicine

Sleep study diagnostics, titration procedures, and CPAP compliance documentation reconciled through to claims and revenue.

What Practices Say

Pulmonology practices, in their own words.

"Our sleep study collections finally match the volume we're doing. Clientele catches coding issues before they become denials."

Practice Administrator
Sleep Medicine Center · Colorado

"DME turnaround used to be our biggest bottleneck. It's no longer even in our top five issues."

Revenue Cycle Director
Pulmonary Associates · North Carolina

"Bronchoscopy coding is finally consistent across every physician in our group."

Practice Owner
Pulmonology & Critical Care Group · Oregon
FAQ

Common questions from pulmonology practices

How does Clientele handle PFT bundling rules?

Our engine applies current bundling logic across spirometry, lung volumes, and diffusion studies so tests billed together follow payer-specific rules automatically.

Can it differentiate in-lab and home sleep study coding?

Yes. Clientele applies the correct CPT set based on study type, titration data, and payer policy before the claim is submitted.

Does it validate DME and CPAP HCPCS codes?

Clientele confirms HCPCS codes and modifiers match the specific device supplied and checks that compliance data is on file before ongoing claims bill.

How does the platform support bronchoscopy coding?

It matches procedure technique, biopsy type, and fluoroscopy use to the correct code and add-on pairing automatically.

Does this replace our pulmonology coders?

No. Clientele’s AI layer works alongside your coding team, validating claims and surfacing issues before submission.

How long does implementation take?

Most pulmonology and sleep medicine practices are fully live within 3 to 5 weeks, including payer and EHR configuration.

Every Breath Matters.
Every Claim Matters More.

See how Clientele's pulmonology intelligence platform validates PFTs, sleep studies, bronchoscopy coding, and DME claims before they ever reach the payer.

HIPAA Compliant SOC 2 Type II Trusted by pulmonology and sleep medicine practices nationwide