CCM pays for the coordination your staff already does. Here are the patient test, the time thresholds, the consent rule and the monthly workflow.
Chronic Care Management Billing: 99490 Time and Consent Read More »
A CARC says why a claim was adjusted. The RARC says what to do next. Learn to read both, and sort correctable errors from real appeals.
CARC RARC Codes: Read a Denial Before You Appeal Read More »
A credentialing audit checks dates, not paperwork. Here is the document set, the verification window, and the gap explanations a reviewer expects to find.
What a Payer Asks For in a Credentialing Audit Read More »
ABA reauthorization fails on documentation long before clinical grounds. The progress data, plan updates and timelines payers expect from ABA practices.
ABA Reauthorization: Proving Medical Necessity With Data Read More »
How critical care time is counted, what 30, 74 and 104 minutes buy, the services bundled into 99291, and the documentation that fails review.
Critical Care Coding: Time, Documentation and 99291 Read More »
The AWV has a fixed element list and a 12 month clock. Here is how to choose G0438 or G0439, document every element, and bill a same day problem visit.
Annual Wellness Visit Billing: G0438, G0439 Documentation Read More »
A payer that never answers an appeal is running your clock out. Use decision windows, acknowledgment rules and regulator escalation to move a silent file.
Appeal No Response From Insurance: What to Do Read More »
The CMS-855B enrolls the group. The CMS-855I enrolls the clinician. Here is which form your practice files, and how reassignment connects the two records.
CMS 855B vs 855I: Which Medicare Enrollment Form Read More »
Unit rates, supervision ratios and reauthorization windows decide ABA margin. What to negotiate in an ABA insurance contract before you sign.
ABA Payer Contract Terms to Negotiate Before You Sign Read More »
How to code annual physicals: preventive E/M codes by age, modifier 25 for a same-day problem visit, vaccine administration and payer screening rules.
Annual Physical Coding: Preventive Visits and Add-Ons Read More »
