Key Takeaways Physician billing covers the professional component: the physician’s exam, interpretation, judgment, and written report. Facility billing covers the technical component: the equipment, technicians, supplies, and overhead used to deliver the service. Modifier 26 reports the professional component only. Modifier TC reports the technical component only. No modifier means one entity is billing both […]
What is Revenue Cycle Management?
Key Takeaways Revenue cycle management (RCM) covers every financial step from scheduling a patient visit to fully resolving the account balance. RCM includes eligibility verification, charge capture, coding, claims submission, payment posting, denial management, and reporting. Medical billing is one part of RCM, not the whole of it. Problems that surface as denials often trace […]
Medical Billing Company vs. Revenue Cycle Management Company: What’s the Difference?
Key Takeaways A medical billing company handles claims submission, coding, and payment posting. A revenue cycle management company manages billing plus credentialing, patient billing, reporting, and often the practice management software itself. Medical billing is one function inside the broader revenue cycle, not a separate category. The two terms are used interchangeably across the industry, […]
Why Practices and Labs Switch Medical Billing Companies
Key Takeaways Practices rarely decide to leave a billing vendor over one incident. It’s usually the accumulation of smaller, unresolved issues that eventually forces the decision. The reasons span the entire relationship, claims accuracy, communication, compliance, even how patients experience billing, not just one type of failure. Several of the most common reasons have nothing […]
Denial Management FAQ: Process Questions Billing Teams Ask Most
Key Takeaways A rejection stops a claim before payer review; a denial means the payer reviewed it and declined to pay. Hard denials are not recoverable; soft denials can be corrected, resubmitted, or appealed — and the distinction should drive triage decisions. Medicare Part A and B redeterminations must be filed within 120 days of […]
What to Look for in a Medical Billing Company
Key Takeaways Specialty experience is the most important differentiator among medical billing companies. Dedicated account management improves communication, accountability, and long-term financial results. Performance-based pricing aligns your billing partner’s incentives directly with your practice’s revenue. Strong denial management and pre-submission claim scrubbing are measurable indicators of billing quality. Technology only produces results when it is […]
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 […]
What Credentialing Delays Really Cost Your Practice
Key Takeaways Provider credentialing typically takes 90 to 120 days — and during that window, in-network billing is not yet possible. Services rendered before enrollment is complete are either denied outright or subject to narrow retroactive billing windows that vary by payer. Medicare’s retroactive billing window is narrow by design — services rendered well before […]
Medicare Billing for Chiropractors: Coverage Rules, Exclusions, and the Mistakes That Lead to Denials
Key Takeaways Medicare covers exactly one chiropractic service: manual spinal manipulation to correct a subluxation. Every other service a chiropractor commonly provides — x-rays, E/M visits, massage, e-stim, ultrasound, extraspinal manipulation — is statutorily excluded. The AT modifier is required on every Medicare claim for spinal manipulation. Without it, the MAC denies the claim automatically, […]
Why Nephrology Billing Is Harder to Manage In-House Than Most Practices Expect
Key Takeaways Nephrology practices carry some of the most documentation-intensive billing requirements in outpatient medicine, driven by CKD staging specificity, high-comorbidity E/M coding, and long-term patient management patterns. ICD-10 staging codes for chronic kidney disease directly affect medical necessity determinations — incomplete or unspecified staging is one of the most consistent sources of preventable denials […]