Pulmonology Claims Audit
Pulmonary function testing, sleep studies, bronchoscopy, and chronic respiratory care reviewed together.
With complex respiratory procedures, changing payer policies, documentation requirements, and value-based reimbursement models, pulmonology practices are under growing pressure to get reimbursed. With ZechionMed Pulmonology Claims Audit Solution, pulmonary specialists can detect revenue leakage, ensure compliance, enhance coding accuracy, and optimize compliant claim reimbursement.
Our expert audit methodology analyzes the claims, medical records, CPT/HCPCS coding, modifiers, documentation quality, and payer requirements to capture and support all services.
Why is Pulmonology Claims Auditing Important in 2026?
There are various factors that are making the U.S. healthcare reimbursement environment more complex in 2026, including:
- More scrutiny from payers of high-cost pulmonary procedures
- Increase in chronic respiratory disease management programs.
- Growth of RPM and respiratory care models
- A higher share of Medicare Advantage plans in the market.
- More Medicare Advantage plans in the marketplace.
- An increase in documentation requirements for medical necessity.
- Increasing documentation for medical necessity.
- An increase in automated claim reviews from payers that leverage AI-based systems.
- Increase in automated claim reviews from payers using AI-based systems.
- More emphasis on coding compliance and revenue integrity
- Pulmonary practices need to make sure that all diagnostic tests, procedures, and assessments are documented and billed correctly.
What We Cover
Procedure Documentation Audit · Ensures
Pulmonary Function Testing (PFT) Audit
We review:
- Spirometry coding accuracy
- Lung volume testing
- Diffusion capacity testing (DLCO)
- Bronchodilator response testing
- Interpretation and reporting responsibilities
- CPT code validation
- Medical necessity documentation
- Test interpretation compliance
Pulmonary Function Testing (PFT) Audit · Identifies
- ✓ Incorrect CPT selection
- ✓ Missing billable components
- ✓ Incomplete physician interpretation
- ✓ Unsupported medical necessity
- ✓ Underbilling opportunities
Sleep Study Claims Audit
We audit:
- Diagnostic polysomnography
- Home sleep testing
- CPAP/BiPAP titration studies
- Sleep disorder evaluations
- Sleep medicine documentation
- The technician and physician components of billing
Sleep Study Claims Audit · Audit Focus
- Ensure proper sleep study CPT coding
- Proper documentation support
- Medical necessity validation
- Modifier accuracy
- Facility = Billing review performed independently of the professional
Sleep Study Claims Audit · Identifies
- ✓ Incorrect sleep study codes
- ✓ Missing documentation elements
- ✓ Denial risks
- ✓ Improper billing combinations
Bronchoscopy Claims Audit
Our specialists review:
- Diagnostic bronchoscopy
- Flexible bronchoscopy procedures
- Bronchial washing
- Biopsy procedures
- Endobronchial ultrasound (EBUS)
- Navigation bronchoscopy
- Related pathology billing
Bronchoscopy Claims Audit · Audit Areas
- Procedure code accuracy
- The evaluation of the bundle and unbundling the review
- Modifier usage
- Operative note validation
- Documentation completeness
Bronchoscopy Claims Audit · Identifies
- ✓ Missed procedures
- ✓ Incorrect procedure combinations
- ✓ Modifier errors
- ✓ Documentation gaps
COPD Management Claims Audit
We evaluate:
- COPD Clinic visits
- Medication management
- Pulmonary rehabilitation services
- Chronic care management
- Transitional care management
- Remote monitoring programs
COPD Management Claims Audit · Audit Focus
- Documentation supporting complexity
- Care plan requirements
- Time-based billing accuracy
- Compliance to chronic disease management
COPD Management Claims Audit · Identifies
- ✓ Missed reimbursement opportunities
- ✓ Unsupported services
- ✓ Incorrect E/M levels
- ✓ Documentation deficiencies
Respiratory Therapy Billing Audit · Audit Areas
- Respiratory therapy services
- Nebulizer treatments
- Oxygen-related services
- Pulmonary rehabilitation
- Respiratory equipment documentation
Respiratory Therapy Billing Audit · Review Includes
- CPT/HCPCS accuracy
- Medical necessity
- Equipment documentation
- Coverage requirements
- Payer guidelines
Respiratory Therapy Billing Audit · Identifies
- ✓ Claim denials
- ✓ Missing supporting records
- ✓ Incorrect billing practices
E/M Coding Audit
We discuss the assessment and treatment of the lungs:
- New patient visits
- Established patient visits
- Consultations
- Hospital visits
- Critical care services
- Transitional care management
E/M Coding Audit · Audit Focus
- Medical Decision Making (MDM)
- Document of history and examination
- Time-based coding
- Complexity level validation
E/M Coding Audit · Identifies
- ✓ Under-coded visits
- ✓ Over-coded encounters
- ✓ Documentation mismatch
- ✓ Compliance risks
Procedure Documentation Audit
Our documentation review checks:
- Procedure reports
- Physician notes
- Diagnostic interpretations
- Medical necessity statements
- Patient history
- Treatment plans
Procedure Documentation Audit · Ensures
- Any services billed are documented.
- Services billed are documented.
- ✓ Coding is consistent with clinical records.
- The procedures are compliant with the requirements of the payers.
- Auditing is kept up and on track.
What We Cover
Detailed Audit Report
Data Collection
We securely collect:
- Claims data
- EHR documentation
- Charge reports
- Remittance advice
- Coding records
Expert Audit Review
Our auditors analyze:
- CPT codes
- ICD-10-CM diagnosis codes
- HCPCS codes
- Modifiers
- Documentation requirements
Revenue Opportunity Identification
We identify:
- Missed charges
- Incorrect coding
- Denial risks
- Compliance issues
- Documentation improvement areas
Detailed Audit Report
Clients receive:
- Findings summary
- Financial impact analysis
- Coding recommendations
- Compliance risks
- Corrective action plan
What We Cover
Increase Coding Accuracy
Improve Revenue Performance
- Look for lost reimbursement opportunities, and avoid revenue leakage.
Reduce Claim Denials
Avoid the typical problems faced by most payers regarding:
- Medical necessity
- Documentation gaps
- Incorrect CPT coding
- Modifier errors
Strengthen Compliance
Maintain alignment with:
- CMS requirements
- Commercial payer policies
- HIPAA standards
- Coding guidelines
Increase Coding Accuracy
Ensure:
- Correct CPT assignment
- Proper ICD-10 linkage
- Accurate E/M levels
- Complete procedure billing
Ready to strengthen your revenue cycle?
Let our specialty billing team handle the codes, claims, and follow-ups — so your clinicians can focus on patients.
What We Cover
Independent Compliance Review
Specialty-Focused Healthcare Expertise
ZechionMed is familiar with the complexities of billing for the lungs:
- Diagnostic testing
- Procedural services
- Chronic respiratory care
- Sleep medicine billing
Expertise in Coding and Auditing Processes
Our team combines:
- Certified medical coders
- Revenue cycle specialists
- Compliance reviewers
- Specialty-focused auditors
AI-Assisted Audit Intelligence
With technology, ZechionMed is able to identify:
- Coding patterns
- Denial trends
- Revenue leakage
- Documentation risks
- Compliance opportunities
Cost-Effective Alternative
By outsourcing, you do not have to worry about:
- Full-time audit teams
- Additional compliance resources
- Costly audit technology (HIPAA) investments
Independent Compliance Review
External audits provide:
- Objective evaluation
- Reduced internal bias
- Stronger compliance monitoring
Ideal Clients
ZechionMed Claims Audit solutions support:
- Pulmonary physician practices
- Sleep medicine clinics
- Multi-specialty groups
- Pulmonary rehabilitation centers
- Hospital pulmonary departments
- Ambulatory specialty clinics
- Healthcare organizations
What We Cover
Why choose ZechionMed instead of internal auditing?
Why should pulmonary practices perform regular
Why should pulmonary practices perform regular claims audits? Regular audits help prevent:
- Incorrect billing
- Claim denials
- Revenue leakage
- Compliance penalties
- Documentation issues
What pulmonary services does ZechionMed audit?
We audit:
- Pulmonary function tests
- Sleep studies
- Bronchoscopy procedures
- COPD management
- Respiratory therapy
- E/M coding
- Procedure documentation
Can ZechionMed identify lost revenue?
Yes. Our audits identify:
- Missing billable services
- Incorrect coding levels
- Under-coded procedures
- Documentation-supported reimbursement opportunities
How often should pulmonary practices conduct
How often should pulmonary practices conduct claims audits? Many practices benefit from:
- Monthly audits
- Quarterly reviews
- Annual compliance assessments
- The frequency depends on practice size, claim volume, and compliance needs.
Does ZechionMed support Medicare and commercial
Does ZechionMed support Medicare and commercial payer audits? Yes. Our audit methodology reviews claims according to:
- CMS guidelines
- Medicare requirements
- Commercial payer policies
- Specialty coding standards
Is ZechionMed HIPAA compliant?
Yes. ZechionMed follows healthcare data protection practices, including:
- HIPAA-aligned workflows
- Secure data handling
- Confidential audit processes
- Business Associate Agreement (BAA) support
How long does a pulmonology claims audit take?
Typical timelines:
- Small practice audit: 2–4 weeks
- Medium practice audit: 4–8 weeks
- Enterprise review: Customized timeline
Can ZechionMed help after completing the audit?
Yes. We provide:
- Corrective action recommendations
- Coding improvement guidance
- Denial prevention strategies
- Ongoing audit monitoring
Why choose ZechionMed instead of internal auditing?
ZechionMed provides:
- ✓ Specialty expertise
- ✓ Independent review
- ✓ Lower operational cost
- ✓ Advanced audit methods
- ✓ Healthcare-focused compliance knowledge
Contact ZechionMed
ZechionMed Pulmonology Claims Audit Solution
Improve respiratory care reimbursement. Reduce compliance risk. Capture every earned dollar.
ZechionMed helps pulmonary providers build a stronger, more accurate, and financially optimized revenue cycle for the evolving U.S. healthcare market in 2026.