Can it manage billing for outpatient parenteral antimicrobial therapy (OPAT)?

Yes. Our platform supports OPAT billing with nursing administration time codes, drug supply units, IV catheter maintenance claims, and required laboratory monitoring follow-ups.

Does it support travel medicine vaccine billing?

Absolutely. We maintain CPT and HCPCS vaccine administration codes for international travel panels, yellow fever, typhoid, and multi-dose hepatitis A/B series billing.

What is the JW modifier and how does it apply to IV antibiotic drug waste in infectious disease?

The JW modifier allows Medicare reimbursement for the unused portion of a single-dose drug vial that cannot be saved. For high-cost IV antibiotics like daptomycin, vancomycin, and cefazolin, our system automatically calculates the difference between the ordered vial size and administered dose, generating separate JW modifier line items to recover waste revenue that typically goes unclaimed in standard billing systems.

How does the platform track CD4 count-triggered authorization renewals for HIV treatment?

Our lab result integration layer monitors incoming CD4 count and viral load results from connected laboratory systems. When results cross payer-defined thresholds for antiretroviral therapy continuation or regimen change, the system automatically initiates the renewal authorization workflow, populating the required clinical evidence before staff would otherwise know a renewal is needed.

What support exists for hepatitis C direct-acting antiviral (DAA) prior authorizations?

HCV DAA regimens like Mavyret, Epclusa, and Harvoni require complex prior authorizations documenting genotype, fibrosis score, prior treatment history, and prescriber specialty. Our clearance engine maintains payer-specific step-therapy criteria for each DAA, auto-populates authorization requests from EHR documentation, and tracks the 8–12 week treatment course with automated mid-treatment lab monitoring alerts.

How does the system handle billing for HIV PrEP (pre-exposure prophylaxis)?

Under the ACA, Truvada and Descovy for PrEP must be covered with zero cost-sharing by most commercial plans. Our intake engine flags PrEP-eligible patients, verifies the plan's PrEP coverage tier, and routes claims correctly to prevent cost-sharing applications. For Medicaid patients, we track state-specific PrEP formulary requirements and prior authorization pathways.

Can the platform manage billing for HIV resistance testing and genotyping?

Yes. We support HIV genotypic resistance testing (CPT 87901, 87906) and integrase resistance testing (CPT 87900), verifying that the ordering provider documentation includes the clinical indication (treatment failure, new HIV diagnosis), confirming prior authorization when required, and sequencing the resistance assay code with the viral load (CPT 87536) to present a complete clinical picture for payer review.

Infectious Disease PM & RCM Software

The Leading Practice Management and RCM Billing Software for Infectious Disease

Streamline antiviral drug authorizations, IV antimicrobial waste billing, and viral load-driven renewal cycles. See why infectious disease practices choose Unlimited Systems for practice management and RCM software.

Why Infectious Disease billing is different

Infectious disease practices navigate extraordinarily complex billing environments, managing HIV prophylaxis programs, antiretroviral drug monitoring, hepatitis C cures, and high-cost IV antimicrobial therapy regimens, all under intense payer scrutiny and strict prior authorization criteria.

A single course of IV antibiotics in an outpatient infusion suite requires simultaneous authorization confirmation, drug waste tracking, nursing administration time billing, and post-treatment laboratory monitoring code sequencing. Generic RCM platforms miss these multi-dimensional claim layers entirely.

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★★★★★4.8/5

★★★★★5/5

6,500+ specialty providersSOC 2 certified

Care team in scrubs walking through a clinic corridor

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Infectious Disease workspace preview coming soon

HOME SPECIALTIESInfectious Disease RCM Software

Trusted Payer & EHR Integration Partners

6,500+

providers nationwide

$70B+

in claims processed annually

4.8/5

average client rating

Designed Around How Your Infectious Disease Practice ACTUALLY Works

Our connected workflows are built to make you and your work easier to do and increase your revenue.

Visit-ready

Keep authorization and coverage aligned before the appointment is booked.

Claim-ready

Validate infectious disease codes, modifiers, and documentation before submission.

Practice-ready

Give teams one view of denials, margin, and A/R priorities.

Specialty RCM intelligence

Infectious Disease Revenue Cycle Challenges

Long-acting antiretrovirals and specialty biologics are transforming ID billing.

16%

Est. denial rate

8/10

Prior-auth burden

Where revenue is at risk

HIV Long-Acting Injectable ARVs

Cabenuva monthly or bimonthly injections split between Part B and Part D depending on administration site.

How the platform addresses this

Injection intervals are validated against documented administration.
Buy-and-bill margin is modeled per agent and payer.
Authorization tracks with the injection schedule.

See it on your own claims

Buy-and-bill drug reference5 agents · codes, channel, prior-auth, and billing notes

Drug	Code	Route	Channel	Cost	PA	Billing notes
Cabenuva (cab + rilpivirine)	J0740 / J2350	IM	Part B	$22K/yr	Yes	Monthly or bimonthly; refrigerated; scheduling critical.
Sunlenca (lenacapavir)	J0222	SQ/oral	Part B/D	$42K/yr	Yes	Twice-yearly SQ; payer policy evolving.
Vancomycin (IV)	J3370	IV	Part B	Varies	Sometimes	OPAT; weight-based dosing and trough levels required.
Cefepime (IV)	J0692	IV	Part B	Varies	No	OPAT antibiotic; infusion duration documentation critical.
Beyfortus (nirsevimab)	Q2056	IM	Part B/VFC	$500/dose	Sometimes	RSV prophylaxis; payer coverage rapidly evolving.

Cabinet integration: ID practices running OPAT services depend heavily on cabinet integration. Weight-based antibiotic dosing makes partial vial wastage routine, and without ADC-to-EHR linkage, JW modifier compliance is hard to maintain at scale.

Real Infectious Disease Practices, Real Results

See how infectious disease groups across the country use Unlimited Systems to lift collections, cut denials, and reclaim staff time.

Featured Practice

Infectious Disease Partners of the Midwest

Columbus, OH14-provider group practice

“Unlimited Systems gave our infectious disease billing team the specialty-specific automation we could never get from a generic platform. First-pass claim acceptance climbed fast.”

- Director of Revenue Cycle

23%

Fewer denials

11 days

Faster A/R

Calculate Your RCM Revenue Leakage

Drag the sliders to estimate how much unrealized cash remains locked in your current specialty billing cycles before optimization.

Model your current claim volume

Adjust both inputs to match your practice.

Monthly specialty claims1,500

200 claims15,000 claims

Average claim value$250

$80 value$3,500 value

Estimated annual revenue recovered

$315,000

Calculated using a 7.0% reduction in write-offs from rejection recovery, pre-authorization verification, and drug-waste capture.

Monthly invoiced volume: $375,000
Standard industry loss: $31,875

Unlimited Systems Guarantee: Fully integrated bi-directional EHR triggers maintain first-pass bill submission scores above 98.6% across regional payer rules on day one.

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See your recovery estimate

Enter your work email to unlock your estimated annual recovery.

See Your Results Immediately5/55/54.8/5

One platform for every infectious disease workflow

Eight connected capabilities, grouped around the way your practice works.

Front office

Keep registration and appointment calendars in sync.

Patient intake Scheduling

Before the visit

Verify coverage and catch charge risk early.

Financial clearance Charge validation

Revenue cycle

Post payments, route denials, and prioritize A/R.

Payment and denials A/R management

Practice intelligence

See margin, performance, and value-based results.

Analytics Value-based care

The Infectious Disease suite

Every part of the infectious disease revenue cycle, in one system

Each module is configured for the codes, modifiers, and payer rules infectious disease teams work with, not adapted from generic billing software.

Infectious Disease Patient Intake SoftwareVerify HIV, hepatitis, and specialty infectious coverage prior to treatment plan activation.Infectious Disease Scheduling SoftwareCoordinate IV antimicrobial chair times, lab follow-ups, and viral monitoring visits.Infectious Disease Financial Clearance SoftwareAutomate step-therapy requirements and prior auths for HIV antiretrovirals and HCV cures.Infectious Disease Charge Validation SoftwareCalculate IV antimicrobial drug waste units and apply JW/JZ modifiers automatically.Infectious Disease Payment Posting SoftwareReconcile specialty pharmacy invoices against payer remittances for complex drug claims.Infectious Disease AR Management SoftwareFlag high-risk authorization gaps before treatment sessions generate uncollectable losses.Infectious Disease Analytics SoftwareCompare drug acquisition costs, payer spreads, and collection rates per treatment protocol.Infectious Disease Value-Based Care SoftwareSubmit HRSA and MIPS quality measures on viral suppression and HIV screening rates.

The cost of generic billing

You went into infectious disease to treat patients, not to chase claims

These are the places infectious disease practices most often lose revenue when their billing platform wasn’t built for the work. Unlimited Systems closes each one with rules configured for your specialty.

Review your workflow

Common infectious disease revenue leaks

Recurring prior authorization denials on high-cost antiretroviral and hepatitis C drug regimens.
Undocumented IV antimicrobial drug waste leading to significant JW modifier revenue losses.
Difficulty tracking rapid re-authorization cycles tied to patient CD4 counts and viral loads.
High administrative burden billing complex travel medicine panels and international vaccine series.

Challenges we solve for infectious disease

The work that generic platforms leave to your staff is the work infectious disease margin actually turns on.

Antiretroviral Authorization

Real-time step-therapy crosscheck auto-populates clinical evidence for same-day authorization.

IV Antimicrobial Waste

Vial-to-billing reconciliation automatically calculates and claims residual waste units.

Lab-Triggered Renewals

Lab result feeds automatically trigger authorization renewal workflows when thresholds are met.

Legacy software vs. Unlimited Systems

See why infectious disease practices move off general-purpose billing platforms.

CRITERIA

LEGACY SYSTEM COMPROMISE

UNLIMITED SYSTEMS VALUE

Antiretroviral Authorization

✕Manual step-therapy documentation delays HIV treatment initiation by days.

✓Real-time step-therapy crosscheck auto-populates clinical evidence for same-day authorization.

IV Antimicrobial Waste

✕Drug waste on high-cost IV antibiotics goes unclaimed due to missing JW modifier workflows.

✓Vial-to-billing reconciliation automatically calculates and claims residual waste units.

Lab-Triggered Renewals

✕Authorization renewals linked to CD4/viral load thresholds are missed without calendar tracking.

✓Lab result feeds automatically trigger authorization renewal workflows when thresholds are met.

Still evaluating

Not Ready to Switch Yet? That's Exactly When to Start the Conversation.

You don't have to be actively replacing your current system to have a useful conversation with Unlimited Systems. Many infectious disease practices talk with us months before a contract renewal or system evaluation to understand where OPAT billing, long-acting antiretroviral scheduling, 340B documentation, and culture documentation may already be showing up.

Get a Demo Benchmark Your Current Workflow

A conversation can help identify where OPAT administration coding, Cabenuva schedule-based dispensing, Part B versus Part D channel decisions, and 340B compliance documentation may be putting revenue at risk.

Less billing work between the visit and payment

Specialty rules and connected data keep your team focused on the exceptions that need judgment.

Verify before the visit

Coverage and authorization stay tied to the order.

Validate specialty charges

Code, unit, and modifier checks happen before filing.

Work the right accounts

Denials and A/R are ranked by value and filing risk.

35%less manual workflow time

One platform

The rest of the platform your infectious disease practice runs on

The same connected system handles the operational work that sits either side of billing.

Patient Intake

Digital intake, eligibility, and demographic capture before the visit.

Explore Patient Intake

Patient Scheduling

Smart calendars and resource scheduling across providers and locations.

Explore Patient Scheduling

Financial Clearance

Automated eligibility checks and prior authorization management.

Explore Financial Clearance

Charge Validation

Pre-claim scrubbing for coding, modifiers, and compliance accuracy.

Explore Charge Validation

Built for infectious disease

Follow one infectious disease patient from intake to payment

Eight stages, one record. Nothing is rekeyed between systems, so a detail captured at the front desk is still there when the claim goes out, and when the remittance comes back.

Walk the workflow with us

Frequently asked questions

We support both commercial insurance and AIDS Drug Assistance Program (ADAP) billing pathways, correctly sequencing payer coordination rules to protect medication access for patients.

New to revenue cycle terminology? Browse our healthcare RCM & billing glossary.

We Love Hearing From Our Users

Practices like yours, on what changed after moving to Unlimited Financials.

EXPLORE PRODUCTS GET A DEMO

★★★★★4.8/5

★★★★★5/5

“

I'd love to set up a call to talk about SCOA, and the success we've had with Unlimited Financials.

Sam Wheeler

CFO, SCOA

“

The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.

Ernelita Dacumos

Billing Manager, SHOM

“

Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.

Melissa Shook

Medical Biller, SHOM

“

I would recommend Unlimited Financials to other specialty practices.

Michelle Leandri

CEO, NEPA

“

We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.

Gina

Administrator, FOUR

“

We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.

Renee Bernacchi

Accounts Receivable Coordinator, COAS

“