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 […]