Key Takeaways Medicare pays for behavioral health integration (BHI) through two models: psychiatric collaborative care (CoCM), billed with 99492, 99493, 99494, and G2214, and general BHI, billed with 99484, or with G0323 when a clinical psychologist or clinical social worker is the treating practitioner. The standalone BHI codes are monthly and time-based, so each claim […]
CPT 87798 vs. 87801: Why Medicare Is Denying Multiple Units
Key Takeaways Medicare Administrative Contractors are denying claims that bill one unit of CPT 87798 for each organism detected by a single multiplex infectious disease panel. The National Correct Coding Initiative (NCCI) Policy Manual, Chapter 10, says a test for multiple infectious agents is reported with one unit when one procedure, one methodology, or one […]
Behavioral Health Carve-Outs: Why Mental Health Claims Go to the Wrong Payer
Key Takeaways A behavioral health carve-out moves mental health and substance use disorder benefits from the medical plan to a managed behavioral health organization (MBHO), whose name may not appear on the front of the patient’s insurance card. Claims sent to the medical plan for carved-out services typically deny with CARC 109, which signals the […]
How to Evaluate an Emergency Medicine Billing Company
Key Takeaways An emergency medicine billing company works the professional claim from hospital-sourced data, since federal rules keep insurance questions from delaying emergency screening and stabilization. Its coders need to level ED visits on medical decision making alone, the CPT standard since 2023. Critical care has to be coded by payer, because Medicare and CPT […]
What CMS’s Preliminary 2027 CLFS Rates Mean for Lab Reimbursement
Key Takeaways CMS released preliminary 2027 Clinical Laboratory Fee Schedule (CLFS) rates on Sept. 21, based on private payer data laboratories reported between May and July 2026. Of 1,528 lab codes with a private payer weighted median, 1,171 fall below their 2026 Medicare rate. CMS puts the average potential change at about 16% lower. Genomic […]
What’s the Difference Between Physician Billing and Facility Billing?
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, […]
The Coding and Billing Mistakes Behind Denied Behavioral and Mental Health Claims
Key Takeaways CPT 90832, 90834, and 90837 are separated by strict, non-negotiable time thresholds. Defaulting to 90837 without matching documentation is a common audit trigger. Standalone psychotherapy codes cannot be billed alongside an E/M code on the same date of service. Add-on codes 90833, 90836, and 90838 exist specifically for combined therapy and medication management […]
Labs Got a Reprieve on PAMA Cuts for 2026, But 2027 Is a Different Story
Key Takeaways Congress blocked scheduled Clinical Laboratory Fee Schedule cuts for 2026 through the Consolidated Appropriations Act, 2026, signed February 3, 2026. The 2026 PAMA reporting window ran May 1 through July 31, 2026, and has already closed. Labs reported private payer data from January through June 2025, not the outdated 2019 data originally planned. […]