Medical Billing

How to Appeal a Denied Medical Billing Claim I see you just opened a denial letter. I know that feeling. Your stomach drops, and you start wondering what went wrong. Take a breath. You are not the first to get one, and you won’t be that last. Denials happen all the time in U.S. billing,…

Clean Claim Rate: Hitting At Least 97% Consistently (Not a Stretch Goal) Most revenue cycle managers can tell you their clean claim rate off the top of their head. What they usually cannot tell you is which two or three things are keeping it below 97%. HFMA puts industry initial denial rates above 11%, and…

Incident-To Billing Rules: What Counts and What Doesn’t Medicare is split into parts. Part A covers hospital stays. Part B covers outpatient visits, doctor appointments, and preventive services. Incident-to billing lives inside Part B. A non-physician practitioner (NPP), which is the umbrella term for providers like nurse practitioners and physician assistants who are licensed to…

Charge Capture: Top 10 Leakage Points in Ambulatory Practice Ambulatory practices lose between 3% and 5% of net patient revenue to charge capture failures every year. On a $5 million practice, that is up to $250,000 annually, and none of it shows up as a denial. The work happened. The money just never made it…

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…