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 […]
What Is a Clean Claim Rate? Benchmarks, Calculations, and What the Number Won’t Tell You
Key Takeaways A clean claim rate measures the percentage of claims accepted by the payer on first submission, without rejection or request for additional information Industry benchmarks, including those referenced by HFMA, put the target for high-performing operations at 98% — most practices land between 85% and 95%, and that gap has a direct dollar […]
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 […]
The Billing Gap Between Telehealth and In-Office Mental Health Visits
Key Takeaways Telehealth and in-office mental health visits require different place-of-service codes, and submitting the wrong one is one of the most common sources of avoidable denials. Modifier requirements vary by payer — and modifier rules for audio-video telehealth have shifted over time, so assumptions based on older workflows may no longer be accurate. Documentation […]
Colonoscopy Billing: When Screening Becomes Diagnostic
Key Takeaways A colonoscopy that begins as a screening procedure can become diagnostic mid-procedure, and that shift carries significant billing and reimbursement implications that many GI practices handle inconsistently. Medicare and most commercial payers require different codes, modifiers, and documentation depending on how a procedure is classified, and errors in that classification are among the […]
Toxicology Lab Billing: Why Payer Scrutiny Is Getting Harder to Navigate
Key Takeaways Payer scrutiny of toxicology lab billing has intensified significantly, with Medicare Administrative Contractors and commercial insurers applying stricter medical necessity and documentation standards. Definitive and presumptive drug testing require distinct coding approaches, and errors in distinguishing between them are among the most common sources of toxicology claim denials. Local Coverage Determinations vary by […]
Medical Billing Process: What Should Happen After a Claim Is Submitted
Key Takeaways The medical billing process continues long after a claim is submitted A significant portion of claims require follow-up, correction, or appeals before payment is finalized Denials, delays, and underpayments are often recoverable with consistent revenue cycle management processes High-performing medical billing companies manage the full lifecycle with visibility and accountability Claim Submission Is […]
White Paper: Why Laboratory Billing Breaks Down (And How LIS-RCM Integration Fixes It)
Why Seamless Integration Between Your LIS and RCM Systems Is Essential for Lab Financial Success Clinical laboratory billing often breaks down when laboratory information systems (LIS) and revenue cycle management (RCM) workflows operate separately. This white paper explains why the disconnect occurs and how integration helps laboratories reduce denials and improve reimbursement. Executive Summary Clinical […]
Revenue Cycle Management Outsourcing: How the Right Medical Billing Partner Improves Financial Performance
Key Takeaways Revenue cycle management outsourcing can improve reimbursement, reduce denials, and stabilize cash flow for healthcare organizations. The modern billing environment requires expertise in coding, compliance, payer rules, and technology integration. End-to-end RCM partners manage the entire process from eligibility verification through collections, improving accountability and performance visibility. Technology, automation, and AI-driven claim scrubbing […]