Rheumatology Billing Services

You treat the patient.
We bill the drug

Rheumatology is different. Your practice buys the drug, gives it to the patient, and only then learns whether the claim will be paid. An expired approval or a wrong unit count means you lose the drug, not just the fee. Our rheumatology billing services check all of that before the patient sits down.

96%avg. net collection rate across TruCare clients

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Results our clients report

96%

average net collection rate across TruCare clients

>95%

clean claim rate, accepted on first submission

−37%

fewer claim rejections

−38%

days in A/R

Figures reflect TruCare client results across specialties, trailing twelve months.

Why practices choose our rheumatology medical billing services

4.8

Based on 180+ client reviews

Verified client reviews

Jul 08, 2026

We stopped eating infusions

Twice last year, we gave a drug on an approval that had quietly run out. That is thousands gone. Every dose is checked against the approval now, before it is drawn up.

Yvette Marchetti, practice administrator

last week

The unit counts finally match

Our J-code units and the vial sizes did not line up, and nobody caught it for months. They rebuilt how we report units and waste, and the underpayments stopped.

Bridget Nwosu, infusion nurse manager

May 27, 2026

My visits are not denied anymore

I was seeing patients and injecting the same day, and the visit kept falling off the claim. They showed me what the note has to say. It has not happened since.

Dr. Arun Kapadia, rheumatologist

Apr 14, 2026

Renewals come to me now

I used to find out that an authorization had expired when the claim was denied. I get a list six weeks out instead, and I work from that.

C. Barrow, prior authorization coordinator

Mar 02, 2026

I know what the drugs actually earn

Drug cost against drug payment, by product. That number used to be a guess. It is not a comfortable number, but at least now I have it.

Dr. Helena Strauss, managing partner

What we take care of for you

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We get your providers enrolled

TruCred files Medicare, Medicaid, and commercial enrollments and keeps your records current. Adding a rheumatologist or an advanced practice provider is handled the same way, and revalidation dates are tracked so nobody drops off a panel.

Medicare enrollmentPECOS upkeepRevalidation

Your biggest claim is a drug you already paid for

In most specialties, a denied claim costs you a fee you have not earned yet. In rheumatology, it can cost you a drug you bought, stored, and put into a patient.

That changes what billing has to do. The checking has to happen before the dose, not after the denial. Is the approval still active? How many doses are left on it? Does the plan still cover this product? Did the patient switch insurance since the last visit?

The rest of the practice is detailed in its own way. A visit and an injection on the same day need a modifier and a note that supports both. Units have to match the vial, not the dose. Ultrasound-guided injections have their own codes and their own documentation rule.

Billing companies that treat rheumatology like a clinic specialty get the visits right and lose the drugs. The drugs are most of the money.

Six ways a rheumatology claim loses money

The approval ran out mid-course

Approvals cover a set number of doses or a set number of months. When one lapses and nobody notices, the next infusion is given anyway, and the practice absorbs the drug cost.

The units did not match the vial

A J-code is billed in units, and those units rarely equal one vial. Get the conversion wrong, and you are underpaid on every dose, or you are over-reporting and exposed if anyone looks.

Waste was given but never recorded

When part of a vial cannot be used, that amount has to be documented and reported properly. Practices that skip it simply absorb the cost of the discarded drug.

The visit fell off the injection claim

An office visit on the same day as a procedure needs a modifier and a note that stands alone. Without both, the visit is dropped and only the injection is paid.

The infusion time was not supported

Infusion is billed by time, so the record has to show when it started and when it stopped. A missing stop time turns a long infusion into a short one.

The small claims stopped being tracked

Joint injections, ultrasound guidance, bone density scans, in-office labs. None is large on its own. Across a year they are a real share of what the practice earns.

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Our service offerings

Services we bill for rheumatology practices

Infused biologics

The drug and the time in the chair, billed together. Units are matched to the vial, waste is recorded, and the approval is checked before the dose is drawn up.

Self-administered and injectable therapy

Products given in the office rather than infused, plus the visits and teaching around starting a patient on them.

Joint and bursa injections

Small, intermediate, and large joints have their own code for each. When both aspiration and injection are done at one site, only one code applies.

Ultrasound-guided procedures

Guided injections use their own codes rather than a separate guidance charge, and they require a permanent image saved to the chart.

Office visits for chronic disease

Rheumatoid arthritis, lupus, gout, and the long-term follow-up that fills a rheumatology schedule. Coded to the work actually documented.

Bone density testing

DXA scans are billed as a complete service or split between the scan and the reading, depending on how your practice is set up.

In-office laboratory work

The panels and markers you run in-house are billed with the diagnosis that supports them.

Trigger point and soft tissue injections

Billed by the number of muscles treated rather than the number of injections given, which is a distinction payers check.

How we work alongside your team

Billers who understand drug claims

Your claims are handled by certified billers and coders who work on rheumatology accounts. They know what a unit is worth, what waste looks like on a claim, and why a visit gets dropped.

Approvals treated as their own job

Filing, following, and renewing authorizations are not things done between other tasks here. It has staff, a queue, and a calendar.

No new software for your office

We work on top of the system your practice already uses, including Epic, Athenahealth, eClinicalWorks, AdvancedMD, and Elation. Nothing changes for your nurses or your front desk.

The denials we see most in rheumatology

Rheumatology denials follow a short list, and the expensive ones all involve a drug. Almost every one of them can be stopped before the claim exists.

That is where the work belongs. Checking an approval takes a minute. Recovering the cost of a wasted biologic takes months and often does not happen.

Want to know what your denials are costing you?

Send us 90 days, and we will show you the pattern

Request a billing audit

Here is what we catch first:

Expired or missing authorization

The most costly denial in rheumatology because the drug is already gone. We track every approval to its end date and start the renewal early.

Unit and product reporting errors

Units that do not match the vial, or a product code that does not match what was given. Both get denied, and both are audit findings waiting to happen.

Undocumented waste

If part of a vial is discarded, that has to be recorded and reported the right way. Otherwise, the practice simply loses that portion.

Missing modifier on a same-day visit

An office visit billed alongside an injection or infusion needs the right modifier and its own documentation. This pairing draws more review than almost anything else in the specialty.

Infusion time not supported

Time-based billing needs start and stop times in the record. Without them, the payer pays the shortest version.

Diagnosis does not support the therapy

Biologics are covered for specific conditions, and the claim has to show the diagnosis and the treatments already tried.

The codes and modifiersbehind your revenue

Our rheumatology billing and coding services run on a small set of codes used thousands of times a year, and on a few rules that decide whether each one holds. Our coders work rheumatology charts every day and know where the money is lost.

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The ones that matter most:

20600 to 20611

Joint and bursa procedures

The code follows the size of the joint, and there are separate codes for procedures done with ultrasound guidance. When both aspiration and injection are performed at the same site in one visit, only one code is reported for that site.

We work in your system and catch what slips

Your clinic day does not change. TruCare connects to Epic, athenahealth, eClinicalWorks, AdvancedMD, Elation, and the other systems practices use, so visits, infusion records, and procedure notes reach billing on their own. No migration weekend. No second login for your infusion nurses.

What you notice is what stops slipping. An approval six weeks from expiry. A dose given without one. Units that do not match the vial. An infusion with no stop time. Those show up on a worklist while they can still be fixed.

See a demo with your EHR

Deep integrations with all EHRs

TruCare connects seamlessly with your existing workflows — no switching required.

What changed for rheumatology in 2026

Medicare’s first negotiated prices took effect

On January 1, 2026, negotiated prices began for the first ten selected drugs. Two of them are rheumatology drugs, discounted by roughly two-thirds of their 2023 list prices.

Those two are pharmacy drugs, not buy-and-bill

Both are covered under the drug benefit rather than billed by your practice. The change affects what your patients pay, not what your infusion suite collects.

The change that does reach you is quieter

From January 1, 2026, sales made at a negotiated price count toward the average sales price that Medicare uses to set drug payment. As that average drifts down, so does the payment basis for Part B drugs.

Office-administered drugs are next in line

The third round of negotiations selected drugs in January 2026 for prices effective in 2028, and it includes Part B drugs for the first time. Several infused rheumatology biologics are in range.

Non-time-based codes lost work value

The 2026 fee schedule applies an efficiency adjustment of 2.5 percent to the work value of codes that are not billed by time. Injections and procedures sit in that group. Time-based visits do not.

There are now two conversion factors

Medicare pays at one rate for practices in qualifying advanced payment models and another for everyone else. Worth confirming which applies to you.

How we keep rule changes from costing you

Someone has to read the fee schedule, the drug pricing updates, and each payer bulletin. That is part of what you are paying us for.

When a payment basis moves or a coverage rule changes, it goes into our claim checks rather than into your denial pile a month later.

We also compare what a payer paid for a drug against what you paid for it. If the two do not work, that is a conversation worth having early.

In-house vs. outsourced

Can one billerhandle an infusion practice?

An in-house biller knows your patients and your physicians. But a rheumatology practice asks that person to run authorizations, watch renewals, reconcile drug units, and still send the visits out. Whether one desk can hold all of it is the honest question. Outsourcing rheumatology billing services is the other way to answer it.

The question	In-house billing	With TruCare
Authorizations	Filed between phone calls and everything else	A queue with staff, tracked to the expiry date
Renewals	Noticed when a claim is denied	Flagged weeks before the last approved dose
Drug units and waste	Easy to get wrong, hard to notice	Reconciled against the vial on every dose
Same-day visits	Dropped quietly off injection claims	Checked for the modifier and the documentation
Infusion time	Billed from habit	Billed from the start and stop times recorded
Payment vs. drug cost	Rarely compared	Compared, so a losing product is spotted early
Rule changes	Read about later	Built into claim checks when they take effect
Cost shape	Salary, benefits, training, software	A percentage of collections, so it moves with volume
Absence and turnover	One departure stalls approvals for weeks	Staffing the desk is on us
What the owner sees	A report built on request	Denials, approvals, and drug margin, live

Want to see where your practice stands? Send us 90 days of denials and aging A/R.

Hover a state to see coverage

Where we serve

Rheumatology billing in every state

We work with solo rheumatologists, multi-site groups, practices with their own infusion suites, and pediatric rheumatology. Drug coverage rules differ by plan and by Medicare contractor, so we handle them one at a time rather than from a template.

Prior authorization

Buy-and-bill drug claims

Infusion billing

In-office labs and imaging

Multi-state enrollment

A named account contact

Who we bill every day

Medicare Part B

Drug payment rules, contractor coverage policies, and infusion claims

Medicare Advantage

Authorization and step therapy rules that differ plan by plan

Medicaid and managed Medicaid

State programs and MCO plans

BCBS and Anthem

Biologic policies that vary by plan

Centene family

Molina, WellCare, Amerigroup

Other

VA Community Care and self-pay

We bill whatever plans your practice is contracted with. If you are not contracted yet, TruCred handles the enrollment.

Rheumatology billing saver guide

A practice collecting $900,000 saves up to $50,650 a year by outsourcing to TruCare

	In-house billing	With TruCare	Annual saving
Dedicated billing staff	$73,060	$0	$73,060
Billing software and clearinghouse	Varies	Included	—
Training, turnover, and coverage	Varies	Included	—
TruCare fee (from 2.49% of collections)	—	$22,410	—
Total annual cost	$73,060	$22,410	$50,650

Example: a practice collecting $900,000 a year with one full-time biller, at TruCare’s starting rate of 2.49%. Biller cost uses the BLS May 2025 median wage for medical records specialists ($51,140), with benefits at 30% of total compensation. Software and training costs vary by practice and are not counted. We do not replace your front desk, we take the claims work off it. Larger groups are quoted on volume rather than at the starting rate, so a bigger practice should not scale this example up.

Want this run on your own numbers?

Talk to a rheumatology billing expert

What the first quarter looks like

““We thought our problem was slow payers. It was not. We were giving drugs on approvals that had expired, billing units that did not match the vials, and losing the office visit every time we injected someone. None of that was visible until somebody went looking. The fixes were not complicated. Nobody had owned them.””

Dr. Helena Strauss

managing partner, Fairmount Rheumatology

You treat the patient. We bill the drug