PGM: Allergy and Immunology Billing Experts
Contact PGM today to learn why practices nationwide outsource their allergy and immunology billing us. You’ll speak to one of our billing experts who will explain how we work to ensure clients are always paid what they deserve, helping generate more revenue to support growth while lowering the cost of running an allergy and immunology practice.
Allergy and immunology practices have choices for where they can outsource their revenue cycle management. More and more are choosing PGM.
What can PGM do for your bottom line? Find out today.
PGM Billing: The Provider of Choice for Allergy and Immunology Practices
The fields of allergy, immunology, and ENT (otolaryngology) are highly specialized, involving an extensive array of diagnostic procedures, treatments, and therapies that require an exceptionally refined and sophisticated approach to medical billing. Successfully navigating the intricate complexities of this domain is absolutely essential to securing precise and timely reimbursement while simultaneously ensuring full compliance with ever-evolving insurance policies, as well as continuously shifting federal regulations.
At PGM Billing, we provide end-to-end medical billing solutions, uniquely tailored to meet the precise needs of allergy, immunology, and ENT practices. Our goal is to streamline the billing process, mitigate financial risks, and ultimately enhance the revenue cycle management for your practice.
Why Allergy and Immunology Billing is Unique
One of the most significant challenges in allergy billing is the vast variability in reimbursement protocols across numerous insurance payers. This is especially true when billing for specialized services such as allergy testing, immunotherapy, and serum preparation. Each individual payer has its own set of unique rules that govern what can be billed, how services must be coded, and the specific reimbursement rates for each distinct service. For example, while some insurance companies allow full reimbursement for multi-dose vials of allergy serum, others impose strict limitations, including caps on reimbursement or restricting coverage solely to maintenance therapy. Failing to fully grasp these nuances can lead to unnecessary denials, frustrating delays in payments, and overall revenue leakage that can negatively impact the financial health of a practice.
For those practices that accept Medicare, the billing intricacies become even more pronounced. Medicare’s distinct and detailed regulations regarding allergy and serum billing differ significantly from the policies followed by private insurers. This includes stringent reimbursement thresholds and highly specific bundling requirements. Failure to strictly adhere to these regulations can lead to significant compliance issues, triggering audits, financial penalties, or even potential fines from the Centers for Medicare & Medicaid Services (CMS).
Comprehensive Allergy & Immunology Billing Services by PGM
PGM specializes in allergy and immunology billing services, providing expertise that ensures compliance, maximizes reimbursements, and minimizes denials. We leverage our extensive industry knowledge to help practices overcome the challenges associated with allergy and immunology billing outsourcing, optimizing revenue cycle management and improving operational efficiency.
Key Areas of Expertise
Allergy Testing and Immunotherapy Billing
Billing for allergy testing is a meticulous process requiring precise coding, as each specific type of test (e.g., skin prick, intradermal, patch testing) necessitates the use of distinct procedural codes (CPT). Furthermore, allergen immunotherapy, whether administered subcutaneously (SCIT) or sublingually (SLIT), requires specialized billing for both the preparation and administration of allergy serums. PGM ensures correct coding and billing for each service provided, factoring in variables such as dose adjustments, build-up versus maintenance phases, and payer-imposed serum preparation caps.
Modifier Management
Accurate application of CPT and HCPCS modifiers is a crucial component of allergy and ENT billing, particularly when billing for multiple procedures within a single patient visit. PGM’s billing team ensures that modifiers (e.g., -25, -59, -76) are applied accurately to prevent claim denials or underpayments. This is especially critical in cases where evaluation and management (E/M) services must be billed alongside procedural services.
ICD-10 Code Selection
Precision in ICD-10 coding is essential for accurately documenting a patient’s condition, whether it be seasonal allergic rhinitis (J30.2) or chronic sinusitis (J32.9). PGM’s certified coders stay fully informed on the latest ICD-10 guidelines, ensuring that your claims are coded correctly and remain fully compliant with payer requirements. This helps significantly reduce the likelihood of denials and eliminates costly reimbursement delays.
The Results: Maximized Reimbursement & Compliance
PGM has a proven track record of helping allergy and immunology practices maximize revenue, reduce billing errors, and increase compliance. Our clients have seen a 20-30% improvement in collections, a 40% reduction in claim denials, and a significant increase in revenue cycle efficiency by leveraging our unmatched allergy and immunology billing company services.
How PGM Delivers the Best Allergy and Immunology Billing Results
PGM is a leader among allergy and immunology billing companies due to our data-driven strategies, advanced technology, and dedicated billing experts. Our success in delivering superior results is driven by the following factors:
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Complete Allergy & Immunology Billing Services
We provide full-spectrum billing services, from claims submission to revenue cycle optimization, ensuring that every aspect of the billing process is handled with accuracy and efficiency. -
Allergy Billing Software Integration
Our innovative allergy billing software is designed to automate complex billing tasks, eliminate human errors, and optimize coding accuracy for maximum reimbursement. -
Advanced Payer Negotiation Strategies
We work closely with insurance providers to negotiate optimal reimbursement rates, ensuring that your practice gets paid fairly for all services rendered. -
Personalized Billing Approach
Unlike generic billing companies, PGM offers highly customized solutions tailored to the unique needs of allergy and immunology practices, including managing reimbursement for immunotherapy and allergy testing. -
Expert-Level Compliance Oversight
Our team stays updated on all federal and payer-specific billing regulations, ensuring full compliance with Medicare, Medicaid, and commercial insurance policies. -
Proactive Denial Prevention
Our team actively monitors claims and identifies potential issues before they result in denials, reducing administrative burdens and improving cash flow. -
End-to-End Revenue Cycle Management
We don’t just submit claims; we manage your entire revenue cycle, from patient eligibility verification to payment posting and financial reporting.
With our expertise in allergy and immunology billing outsourcing, we help practices achieve higher efficiency, improved reimbursement rates, and reduced billing-related administrative burdens. By partnering with PGM, your practice can focus on patient care while we handle the complexities of your revenue cycle.
Allergy Billing Software Solutions
PGM utilizes advanced allergy billing software designed to automate key processes, reduce claim errors, and streamline reimbursement cycles. Our innovative technology solutions help allergy and immunology practices manage patient data, track claims in real-time, and handle complex payer requirements with ease.
Why Choose PGM for Allergy and Immunology Billing Outsourcing?
Allergy and immunology practices require a specialized approach to medical billing due to the complexity of diagnostic testing, immunotherapy, and biologic treatments. At PGM, we provide expert allergy and immunology billing services designed to streamline revenue cycle management, reduce administrative burdens, and maximize reimbursement. As a leading allergy and immunology billing company, we offer comprehensive solutions that ensure accuracy, compliance, and financial success for your practice.
Proven Expertise in Allergy Billing
With decades of experience providing allergy and immunology billing outsourcing, PGM understands the unique challenges faced by allergists and immunologists. From complex coding for allergy testing, venom immunotherapy, oral immunotherapy (OIT), and biologic injections to navigating payer-specific reimbursement policies, we ensure that every claim is processed accurately and efficiently. Our deep industry knowledge allows us to prevent denials, reduce claim rejections, and accelerate cash flow for your practice.
Certified Billing Professionals
PGM’s team consists of certified medical billing professionals who specialize in allergy and immunology coding. Our experts stay up to date with the latest CPT, ICD-10, and HCPCS coding changes, ensuring compliance with payer guidelines. We have extensive experience billing for:
- Skin prick testing (CPT codes 95004, 95024)
- Patch testing (CPT 95044)
- Intradermal testing (CPT 95015, 95018)
- Allergy immunotherapy (CPT 95115–95199)
- Biologic therapies (such as Xolair, Dupixent, Nucala, and Fasenra)
- Drug allergy and venom immunotherapy
- Pulmonary function testing
Custom Solutions for Allergy Billing
Unlike other allergy and immunology billing companies that provide generic services, PGM offers customized billing solutions that align with your practice’s unique needs. Our advanced allergy billing software integrates seamlessly with your existing electronic medical record (EMR) system, streamlining workflows and minimizing manual data entry. Our solutions include:
- Automated charge capture to reduce errors and missed billing opportunities
- Custom reporting dashboards for real-time financial tracking
- Integrated eligibility verification to prevent claim denials upfront
- HIPAA-compliant electronic claims submission for faster reimbursement
Maximized Reimbursement for Allergy and Immunology Practices
PGM’s allergy and immunology billing services focus on maximizing reimbursement through a combination of error-free claims submission, optimized coding, and proactive denial management. Our dedicated team ensures:
- Proper coding for combination allergy testing and treatment services
- Accurate documentation to support medical necessity
- Appeal management for underpaid or denied claims
- Negotiation with payers to improve contract rates and reimbursement
With PGM’s allergy and immunology billing outsourcing, your practice benefits from increased revenue, faster payment turnaround, and reduced administrative stress. Let us handle your billing, so you can focus on delivering exceptional patient care.
Exceptional Customer Service for Allergy and Immunology Billing
Allergy and immunology practices require a specialized approach to medical billing due to the complexity of diagnostic testing, immunotherapy, and biologic treatments. At PGM, we provide expert allergy and immunology billing services designed to streamline revenue cycle management, reduce administrative burdens, and maximize reimbursement. As a leading allergy and immunology billing company, we offer comprehensive solutions that ensure accuracy, compliance, and financial success for your practice.
Dedicated, Personalized Support
Unlike larger billing firms that offer one-size-fits-all solutions, PGM provides personalized service tailored to the needs of allergy and immunology practices. Our dedicated account managers work closely with your team, offering proactive communication and quick response times. Whether you have a question about claim submissions, coding updates, or reimbursement denials, our experts are always available to assist.
Expertise in Allergy & Immunology Billing
Our team is well-versed in the nuances of allergy and immunology billing, ensuring accurate claim submissions and maximum reimbursement. We stay up to date on coding changes, payer policies, and regulatory requirements, minimizing denials and delays. From billing for skin prick testing, patch testing, and serum preparation to coding biologic therapies, we handle it all with precision.
Efficient Claims Processing & Denial Management
PGM’s advanced billing technology and proactive approach significantly reduce claim errors and denials. Our team rigorously reviews claims before submission, ensuring correct coding and documentation. If a denial occurs, we act swiftly to correct and resubmit claims, preventing revenue loss and improving cash flow.
Compliance & Regulatory Guidance
Billing for allergy and immunology services requires adherence to strict payer guidelines and regulatory requirements. PGM provides ongoing compliance support, helping your practice avoid costly audits and penalties. Our team ensures that your billing practices align with Medicare, Medicaid, and private insurance policies, giving you peace of mind.
Enhancing Your Practice’s Financial Health
PGM doesn’t just process claims — we actively work to improve your financial performance. With transparent reporting, revenue cycle analysis, and strategic insights, we help your practice maximize profitability while allowing you to focus on patient care.
With PGM as your billing partner, your allergy and immunology practice benefits from expert support, seamless claim management, and a customer-first approach that ensures long-term success.
Learn More About Our Leading Allergy & Immunology Billing Services
Are you ready to optimize your allergy, immunology, or ENT billing process? PGM offers a complimentary consultation and demo to showcase how our tailored solutions can streamline your practice’s revenue cycle while ensuring maximum reimbursement for services rendered.