Five diagnostics drive the outsourcing medical billing decision: claim volume, payer mix, denial composition, staff turnover and cost per collected dollar.
Outsourcing Medical Billing Decisions: A Practice Framework Read More »
A duplicate claim denial usually means the original claim is still in adjudication. Check status first, then correct the claim instead of refiling it.
Duplicate Claim Denials: Why Resubmitting Makes It Worse Read More »
Type 1 and Type 2 NPIs do different jobs on a claim. Which number belongs in item 24J, which belongs in 33a, and what reassignment changes.
Group NPI vs Individual NPI: Where Claims Get Lost Read More »
Place of service, modifiers and audio-only rules differ across Medicare, commercial payers and state Medicaid. Here is how to verify each before the visit.
Behavioral Health Telehealth Billing by Payer and State Read More »
What a valid HCC capture requires under the 2024 CMS-HCC model, the annual recapture clock, and the documentation patterns that trigger a RADV audit.
HCC Coding: Risk Adjustment Without Upcoding Risk Read More »
Incident to billing pays the physician rate in the office. What the 2024 and 2026 rules changed, what they did not, and the record that survives an audit.
Incident to Billing in 2026: Rules, Rates, Audits Read More »
A seven-day denial recovery workflow: triage by reason code and dollars at risk, file inside a fixed window, and reconcile every Friday.
A Seven-Day Denial Recovery Workflow Read More »
A MAC can take up to 100 days on a paper enrollment file with a development request. The four stalls that hold those files, and the deadlines that clear them.
Provider Enrollment Delay: Four Stalls, 30-Day Clocks Read More »
What is billable inside an intake visit, which code carries the assessment, and the same-day pairs that turn a clean claim into a refund.
Intake Billing Behavioral Health: What Is Billable Read More »
The FY2027 ICD-10-CM set takes effect October 1, 2026 with 238 new codes, 21 deletions and 15 demotions. Here is the process and the calendar.
ICD-10-CM 2027 Updates: What Changes for Your Specialty Read More »
