Category: medical billing

Multi-provider practices have billing complexity that solo practices don't: multiple rendering provider NPIs, different payer credentialing per provider, specialty-specific denial patterns across a mixed group. Here's what group practice billing requires and what it costs.

Walk-in eligibility verification under time pressure, S-code confusion, and high-volume claim throughput make urgent care billing uniquely error-prone. Three out of five urgent care claims have at least one issue at submission. Here's what causes them.

Most HIPAA violations in medical billing don't come from data breaches. They come from missing BAAs with billing vendors, unencrypted PHI on freelancer devices, and offshore billing arrangements without proper compliance documentation. Here's what creates exposure and how to close it.

Cardiology has a 15% denial/resubmission rate — nearly triple the typical outpatient rate. The causes are specific: complex modifier requirements, prior auth on high-value procedures, and global billing rules that most general billers don't know.

Workers' compensation billing doesn't follow standard health insurance rules. State-specific fee schedules, claim administrator contacts, and work-relatedness documentation make workers comp billing a specialty within a specialty.

Physical therapy billing has the highest density of technical rules per claim of any outpatient specialty. The 8-Minute Rule alone generates more denials than any other single billing error in PT. Here's what causes PT billing losses and how to fix each one.

Telehealth billing has its own modifier rules, place-of-service codes, and payer-specific requirements that change faster than any other billing area. Dedicated telehealth billing specialists from $7/hr.

A collections rate below 90% isn't a revenue problem — it's a billing operations problem. Six specific causes, each with a specific fix. Most practices find their issue in the first three.

AR over 90 days is money you've earned that's bleeding out through a process gap. Here's the systematic recovery approach — which claims are recoverable, which aren't, and how to prevent the same problem from building up again.

Credentialing gaps don't generate obvious denials. They generate CO-B7 — provider not enrolled with payer — on every claim for that payer until someone figures out what's wrong. Here's how credentialing failures happen and how to prevent them.

Prior authorization failures are the most expensive preventable billing problem. $9,000 denied per missed auth on average. The workflow that eliminates missed auths — and what to do when a payer denies an auth that should be approved.

Practices searching for billing software to fix their revenue cycle problem usually have a staff problem, not a technology problem. Here's how to tell which one you actually have — and what solves each.