Allergy & Immunology Analytics Software

Analytics in a Allergy & Immunology Practice

Revenue in an allergy practice rests on a few repeat patterns. Immunotherapy patients have to keep coming for shots, so missed visits show up first as lost injection revenue and later as patients who drop out. Antigen preparation is paid by the dose, so doses billed should line up with vials prepared and shots given. Testing pays per test, and payers cut units when they think a panel is too large. Biologics bring large payments and real cost. Unlimited Systems analytics puts all of this in one data set. Falling collections might trace back to a payer cutting 95165 units, a new FeNO policy, or fewer shot visits at one site. KPIs such as denial rate and days in AR drill down from the practice to the payer, provider and claim. Benchmarks set each allergy KPI beside its own past values and beside peer specialty averages.

Why Is Analytics Different in Allergy & Immunology?

Allergy revenue depends on patient habits as much as on coding. A maintenance patient who stops coming for shots stops creating claims, yet nothing on a denial report shows it. Analytics that tracks shot visits per patient, the gap since the last injection and progress from build-up to maintenance shows the drop while staff can still reach out.

Payer rules for allergy tests and lung tests also vary widely. Medicare pays allergy tests per test and does not count positive or negative controls. Some commercial payers cover FeNO testing (95012) for asthma, while others call it investigational. NCCI treats the bronchodilator given during 94060 as part of the test, so billing 94640 with it is a misuse. Trends by code and payer show which rules cost the practice money and where a fix belongs.

Biologic margin is the third moving part. Payment for each dose depends on the payer's rate, which for Medicare follows the quarterly ASP file, while cost depends on what the practice paid. A drug can slip from profit to loss when either side changes. Analytics for an allergy group compares payment with cost by drug, payer and quarter, so leaders see the change before the next order.

What Allergy & Immunology Analytics Software Handles

Dose reconciliation for 95165

Medicare bills the doses planned when a vial is prepared, capped by the vial size. Doses billed are compared with vials prepared and shots given, so a gap in either direction shows by provider and site. (Medicare Claims Processing Manual, Chapter 12, Section 200: Allergy Testing and Immunotherapy)

Allergy test units and controls

Medicare does not count positive or negative controls as tests. Paid and cut units for 95004, 95024 and 95018 are trended by payer, so unit problems stand out early. (CMS NCCI Policy Manual for Medicare Services 2026, Chapter XI (pulmonary testing; allergy testing and immunotherapy))

Spirometry 94010 and 94060

NCCI treats the bronchodilator given in 94060 as part of the test, and repeat spirometry tries within one service count as one unit. Denials on these codes are trended by payer and provider. (CMS NCCI Policy Manual for Medicare Services 2026, Chapter XI (pulmonary testing; allergy testing and immunotherapy))

FeNO testing (95012)

Medica covers FeNO for diagnosing eosinophilic airway inflammation and judging steroid response, while Blue Shield of California calls it investigational. Denials for 95012 by payer show which policies reach the practice. (Medica Coverage Policy: Exhaled Breath Tests for Asthma and Other Inflammatory Pulmonary Conditions (CPT 95012))

Biologic margin by quarter

Medicare drug payment follows the quarterly ASP file. Payment for J2357, J2182, J0517 and J2356 is compared with acquisition cost each quarter, payer by payer. (CMS ASP Pricing Files (Medicare Part B drugs))

Denial reasons by code

CARC 151, CARC 119 and CARC 197 are trended by code and payer. Repeat patterns go back as rules for the claim scrubber. (X12 Claim Adjustment Reason Codes)

How Does Allergy & Immunology Analytics Software Work?

1. 1. Pull one data set

   Scheduling, charges, remittances and drug costs sit in one data set. A shot visit, its claim and its payment can be read together.

2. 2. Track the core KPIs

   Collections, denial rate, days in AR and clean-claim rate are tracked by payer, provider and site. Allergy measures add shot visits, missed doses and dose reconciliation.

3. 3. Find why a number moved

   A dip in allergy collections is traced back to the payer, code or site behind it. Users drill from the KPI down to the claims behind it.

4. 4. Benchmark the practice

   The practice is measured against its past results and against peer specialty averages. Gaps show where to look first.

5. 5. Send fixes upstream

   Denial patterns become rules for charge validation. Results go out on a schedule through allergy reporting and appear on dashboards for each role.

Allergy & Immunology Analytics Software vs. Generic Software

Who Uses It in a Allergy & Immunology Practice

• Practice administrator: Shot visit volume, missed doses and collections by site, with the reason behind each change.
• Billing director: Denial rate by code and payer for testing, spirometry, FeNO and biologics, with the claims behind each trend.
• Physician owner: Biologic margin by drug and payer, and a clear view of whether immunotherapy patients are staying on schedule.