Medical Billing & RCM Insights

An out-of-network billing guide to the No Surprises Act IDR process: which claims qualify, how the QPA is set, every deadline from open negotiation to payment, the 2026 batching and fee changes, and the evidence that wins disputes.

An OPAT billing guide for infectious disease physicians: who bills what in the office, infusion center and home, 99417 vs G2212 prolonged services, infusion code sequencing, documentation, IV antibiotic prior authorization and the top denials.

A Wyoming Medicaid billing guide for physicians: DyP enrollment and revalidation, the 12-month timely filing limit, Noridian JF Medicare rules, rural health clinic and critical access hospital basics, and the denials that cost Wyoming practices the most.

An adjustment code shows up on a remittance, pointing back at a claim paid more than a year ago. Recoupment risk usually enters a practice’s

The claim went out clean, got paid, and posted to the ledger. Four months later, an audit letter arrives asking for the note behind it.

ABA therapy billing strategies help behavioral health practices cut claim denials, close authorization gaps, and keep cash flow steady. Applied Behavior Analysis (ABA) billing is

To reduce A/R over 90 days, identify every outstanding claim or patient balance older than 90 days, determine why it remains unpaid, and assign a

Two weeks after the visit, the remittance comes back: coverage ended the day before the appointment. The patient said the insurance was good, and maybe

Your practice can be busy every day and still run short on cash. Often, the problem is not patient volume. Instead, it is aging A/R:

Practice owners usually ask about the types of billing systems in healthcare when they choose new software or an outside billing partner. The answer shapes

How many units should you bill when a physical therapy session lasts 23 minutes? What about 38 or 53 minutes? And does every payer count

For Texas physicians, great patient care is only half of running a healthy practice. Behind every visit sits a revenue cycle of eligibility checks, coding,

Claim denials quietly drain a cardiology practice’s revenue, delay payment, and keep billing staff stuck in rework. Cardiology claims carry complex procedures, prior authorizations, bundling

Every practice reaches a point where it must decide who runs its billing. The choice between in-house vs outsourced medical billing comes down to three

What happens when a provider needs prior authorization, but the request still runs through payer portals, fax, phone calls and manual uploads? CMS is pushing

Healthcare revenue cycle management (RCM) is the process that turns patient visits into collected payments. It covers every step from scheduling and insurance checks to

Medical coding errors cost far more than a single denied claim. Each one can trigger rework, slow payment, underpayment, or a payer clawback months later.

What do credentialing companies do for providers? In short, they handle the verification, payer enrollment and renewal work that lets a clinician bill insurance from