Rheumatology
Healthcare IT and billing built for a rheumatology practice
Infusion therapy, biologic authorization and disease activity tracking for rheumatology practices.
Why rheumatology is different
Rheumatology practices carry unusual financial risk because they purchase expensive biologics and infuse them before payment is assured: a single authorization failure can cost thousands of dollars per dose.
Healthcare SBC protects that margin: authorization verified before drug is ordered, accurate unit and waste documentation, infusion administration coding, and drug inventory reconciled against claims.
Common challenges
Where rheumatology practices lose revenue
The billing and workflow problems specific to this specialty, and the ones generic systems handle badly.
Buy-and-bill financial risk
High-cost biologics purchased in advance create real exposure when a claim denies after administration.
Biologic prior authorization
Step therapy, documentation requirements and reauthorization cycles are heavy and unforgiving.
Infusion coding complexity
Initial, sequential and concurrent administration codes with time documentation determine payment.
Drug waste documentation
Single-dose vial waste must be documented with JW modifiers to be reimbursed.
How we address it
Built for rheumatology workflows
- Authorization verification enforced before drug ordering and administration
- Infusion suite scheduling with chair and nurse capacity management
- Administration time capture driving initial, sequential and concurrent coding
- Drug inventory reconciliation against claims with waste and JW tracking
- Disease activity measures such as CDAI and RAPID3 in flowsheets
Commonly billed codes in rheumatology
A sample of the codes our rheumatology coders work with daily.
- 96413Chemotherapy administration, IV infusion, first hour
- 96365Therapeutic IV infusion, initial hour
- J1745Injection, infliximab, 10 mg
- 20610Arthrocentesis, major joint
- 99214Established patient visit, moderate complexity
Codes shown for reference only. Verify against current code sets and payer policy.
Other medical specialties
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Obstetrics & Gynecology
Global obstetric packages, prenatal tracking and gynecologic procedure billing on one platform.
FAQ
Rheumatology, frequently asked questions questions
- How do you reduce buy-and-bill risk?
- The platform blocks drug ordering and administration until authorization and benefits are verified and documented, so expensive biologics are not infused against coverage that doesn't exist. Inventory is then reconciled against submitted claims to catch any gaps immediately.
- Do you handle biologic prior authorizations?
- Yes. Our team manages initial authorizations, step-therapy documentation, appeals and reauthorization cycles, tracking expiration dates so therapy is never interrupted by an administrative lapse.
- How is drug waste billed?
- Waste from single-dose vials is documented at administration and billed with the JW modifier where payer policy allows, recovering reimbursement that is otherwise simply absorbed as loss.
We're here to help
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