Key Takeaways The ESRD Monthly Capitation Payment (MCP) is a single monthly code, not a per-visit fee, and code selection depends on the patient’s age and the number of face-to-face visits completed that month. Only one MCP claim is allowed per patient per month, and the billing physician must personally provide at least one of […]
Laboratory Billing Errors: Panel Coding, Modifier 91, and Consolidated Billing Gaps
Key Takeaways Organ and disease panel codes carry NCCI edits that block separate billing of individual components once the panel’s components have all been performed. Modifier 91 applies only to medically necessary repeat testing performed to obtain multiple results on the same day, not to work-arounds for frequency edits. Laboratories testing specimens for patients in […]
Chemotherapy and Infusion Billing: Coding Errors That Cost Oncology Practices
Key Takeaways Chemotherapy administration must be sequenced before therapeutic infusions and hydration on every multi-service claim. Start and stop times are required for time-based infusion codes — missing documentation forfeits add-on code reimbursement. The JW and JZ modifiers are mandatory on Medicare claims for single-dose vial drugs; missing either causes claims to be returned unprocessable. […]
Orthopedic Billing Denials: Why Claims Fail by Procedure Type
Key Takeaways Joint replacement denials are most often documentation failures, not coding errors — prior authorization and conservative treatment records have to be in the chart before the claim goes out. Fracture care claims fail at the ICD-10 level more than any other orthopedic category; episode-of-care suffix errors and missing laterality are consistent, avoidable denial […]
Orthopedic Billing Codes: The Errors Costing Surgical Practices the Most
Key Takeaways Global period exceptions require specific modifiers, and each carries a documentation requirement that, when unmet, turns a legitimate claim into a denial or a compliance flag. The multiple procedure reduction rule applies automatically to multi-procedure surgical cases; correct sequencing and modifier 51 exemptions still have to be managed manually. Modifier 22 is warranted […]
Cardiology Billing: The Coding Errors That Keep Costing Practices Money
Key Takeaways Catheterization CPT code selection depends on whether the procedure was diagnostic or interventional and which components were performed — and both have to be right. Errors in this code family are among the most audited patterns in cardiology billing. CPT 93306 requires 2D imaging, M-mode, spectral Doppler, AND color flow Doppler — all […]
Chiropractic Billing Codes: How CPT Selection, Modifiers, and Diagnosis Alignment Drive Denials
Key Takeaways The CPT code for chiropractic manipulative treatment is determined by the number of spinal regions documented as treated — a mismatch between the code and the clinical record is one of the most consistent sources of denials. ICD-10 diagnosis codes must reflect the specific regions being treated; vague or non-specific codes leave claims […]
How to Use a Medical Claim Scrubber: A Step-by-Step Walkthrough
Key Takeaways A medical claim scrubber reviews CPT codes, modifiers, diagnosis codes, and claim structure before submission to flag errors that lead to denials Different specialties produce different types of claim errors — the same pre-submission review process surfaces different issues depending on the claim context AI-powered claim scrubbers identify relationships between coding elements that […]
What Is a Claim Scrubber and Why It Matters More Than Ever
Key Takeaways A claim scrubber reviews coding and claim data before submission to identify errors that lead to denials AI-powered claim scrubber software can detect more complex issues than traditional rules-based tools Effective claim scrubbing improves clean-claim rates and reduces rework across the revenue cycle Early validation supports faster reimbursement and more predictable cash flow […]
Outsourced Medical Billing: The Competitive Advantage Every Healthcare Provider Needs in 2026
Healthcare organizations are under extraordinary pressure as they enter 2026. Declining reimbursements, changing payer rules and tactics, increasing compliance complexity, and workforce shortages are just some of the reasons forcing providers to rethink how they manage every function of their revenue cycle. The message from the market is clear: efficiency and expertise will define success […]