How NCCI PTP and medically unlikely edits work, when modifier 25, 59 or an X modifier is defensible, and how to tell a coding error from a payer error.
NCCI Edits: When a Bundling Denial Is Correct Read More »
Build one page per payer with their denial reasons, appeal address, filing windows and documentation quirks, plus the person who owns it.
Payer Denial Playbook: One Page Per Payer Read More »
NCQA sets the verification windows, the three-year recredentialing cycle and the evidence a payer audits under a delegation. Here is what each step requires.
NCQA Credentialing Standards in Plain English Read More »
How the free care reversal changed school based medicaid billing, the consent and documentation rules, and the supervision that keeps claims paid.
School Based Medicaid Billing: Behavioral Services Read More »
A financial assistance policy under section 501(r) sets who qualifies, the charge cap, the 240-day window and the limits on collections.
Charity Care Policy: Rules, Charges and Collections Read More »
Modifier 59 is a review flag, not a fix for an NCCI edit. What XE, XS, XP and XU state that 59 cannot, plus the chart documentation that survives an audit.
Modifier 59 and XS: The Audit Risk in Unbundling Read More »
Denial rate benchmarks only mean something with the definition attached. What MGMA, HFMA, CMS and KFF each count, and what moves a practice rate.
Denial Rate Benchmark: What a Normal Rate Looks Like Read More »
Opting out of Medicare runs two years and needs an affidavit plus a private contract with each patient. What changes for billing, and when.
Medicare Opt Out: Affidavit, Contracts and Billing Read More »
How 90791, 90834, 90837, 90785 and 90839 differ, when each add-on applies, and the time documentation that keeps the code defensible.
Mental Health Billing Codes in Practice Read More »
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 »
