Modifier 25 pays a same-day E/M only when the note shows significant, separately identifiable work. What Medicare and NCCI require, and patterns that fail.
Modifier 25: E/M Plus Procedure, Done Defensibly Read More »
Telehealth billing splits by payer. Set place of service and modifier from the visit, handle audio-only correctly, and confirm each payer’s rule first.
Telehealth Billing After the Flexibilities: Modifier and POS Rules Read More »
A medical necessity denial is decided by the note, not the diagnosis. What payer reviewers look for and how to cite LCD and NCD language on appeal.
Medical Necessity Denials and the Documentation That Prevents Them Read More »
Medicaid provider enrollment runs on 50 state systems with different fees, revalidation cycles and group rules. How to plan a multi-state rollout.
Medicaid Provider Enrollment: Why State Timelines Differ Read More »
Waiver services bill through their own authority, provider number and authorization. How HCBS claims are set up for a behavioral health practice.
Medicaid Waiver Billing: HCBS for Behavioral Health Read More »
