Key Takeaways Five Medicare Administrative Contractors have proposed LCDs that would eliminate coverage for most peripheral nerve block and denervation procedures for chronic pain. The proposals would leave coverage largely intact for facet joint interventions, epidural injections, and three narrowly defined exceptions. Public comment periods closed in November 2025, and none of the five MACs […]
Cystoscopy, Prostate Biopsy, and Lithotripsy: Where Urology Claims Actually Get Denied
Key Takeaways Urology denials cluster around specific procedures, not one universal coding mistake. CPT 55700 was deleted for 2026 and replaced by a nine-code family that bundles imaging into the biopsy code itself. NCCI edits bundle diagnostic cystoscopy into nearly every therapeutic cystoscopy code performed in the same session. Missing laterality modifiers on lithotripsy and […]
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 […]
The Coding and Billing Mistakes Behind Denied Allergy and Immunotherapy Claims
Key takeaways Allergy testing and immunotherapy use separate, non-interchangeable CPT code sets. Billing the wrong code combination triggers denials regardless of medical necessity. Immunotherapy dose miscounting is one of the most common sources of underpayment. Medicare does not cover complete-service immunotherapy codes; component billing is required. Modifier 25 has specific, narrow rules for same-day E/M […]
Neurology Billing Collections: Where Practices Lose Revenue and How to Recover It
Key takeaways Neurology billing volume does not guarantee strong collections. Time-based E/M documentation gaps delay or reduce reimbursement. Prior authorization requirements for EMG, nerve conduction studies, and imaging create cash flow lags. Botox and infusion billing errors are a common source of lost revenue. Days in A/R and denial patterns reveal where collections break down. […]
Nephrology Billing Errors: ESRD Monthly Capitation Payment Rules Practices Get Wrong
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 […]
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 […]
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. […]
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 […]