Medical Billing

Time-of-Service Collections: How Top Practices Collect 98% The national average for time-of-service (TOS) collection is somewhere between 55% and 65%. That gap between where most practices sit and 98% has nothing to do with patients not wanting to pay. But it has everything to do with what your staff says, when they say it, and…

Medical Billing Audit Checklist for Clinic Owners The revenue problem most clinics never see coming, and the seven-step process that stops it What if the biggest threat to your clinic’s revenue is not the claims that get denied, but the ones that get paid? Denied claims are visible. They show up, they get flagged, someone…

Self-Pay & Patient Payment Plans: A Cash-Flow Playbook for Medical Practices The financial relationship between practices and patients has fundamentally changed. What was once a predictable transaction, bill the insurer, collect a small copay, has become one of the most operationally demanding parts of running a medical practice. Patient payments now account for approximately 35%…

Pain Management Billing: A Coding Guide for Trigger Point, Facet Joint, and Epidural Injections It’s a Wednesday morning and the front desk at a busy pain management practice is fielding its third call this week from a patient confused about a denied claim. Meanwhile, in the back office, the biller is staring at a remittance…

Denial Root Cause Analysis: The 5 Categories to Track Why “working” denials is not the same as eliminating them in the first place There is a difference between a team that fights fires every day and a team that figures out why fires keep starting. In healthcare revenue cycle management, most practices are doing the…

New vs Established Patient Billing: What the 3-Year Rule Actually Means A patient walks into your practice for the first time in four years. Your front desk marks them as established. Your biller codes accordingly. Your claim goes out, and six months later, it surfaces in an OIG audit as upcoding. The 3-year rule got…

ASC Billing Guidelines: What Every Surgery Center Needs to Know CMS is adding 573 new procedure codes to the ASC Covered Procedures List in 2026. Payment rates are adjusting. Quality reporting penalties are in effect. And across the more than 6,300 Medicare-certified ASCs treating nearly 3.4 million fee-for-service beneficiaries annually, the difference between a well-run…

Podiatry Billing: Routine Foot Care & Medicare LCDs Medicare excludes routine foot care from coverage under the Social Security Act, Section 1862(a)(13). That means trimming toenails, cutting corns, and general preventive foot maintenance are not covered services on their own. Medicare considers them maintenance, not treatment. But there is a documented exception. And that exception…

How AI Medical Coders Catch $150K in Missed Revenue Per Year This is a story from one of our clients. At first glance, nothing seemed off. They had twelve physicians, about 280 patient visits a week, and a solid billing team with three experienced coders. But something kept bothering the practice manager. Every month, the…

Physical Therapy Billing: The 8-Minute Rule Explained In most medical specialties, the time a surgeon or a physician spends delivering a service rarely changes what gets billed or how much. However, physical therapy works on an entirely different logic. In PT, time is not just a background detail in the note. Time is what determines…