Medical Billing

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…

Payer Underpayment Recovery: The Hidden 15% Revenue Gap Healthcare organizations spend enormous effort improving denial management, reducing AR days, and accelerating collections. Revenue cycle teams monitor rejected claims closely because denials create immediate operational pressure and visible disruptions to cash flow. But one of the largest sources of revenue leakage often receives far less attention:…

How to Read an EOB in Medical Billing and Catch Underpayments in 10 Minutes By the time the EOB arrives, most teams have already moved on to the next claim. The work is done, the patient has left, and the claim has been processed through the medical billing clearinghouse and on to the payer. So…

The 7 Most Common Claim Denials and How to Appeal Each One I sat in on a customer call a few months back. The billing director of a 40-provider orthopedic group was going through her denial worklist with me. In about twenty minutes, she wrote off $11,000 worth of claims. Most of them, she admitted,…