Documentation Requirements for Neurosurgery CPT Codes
Neurosurgery practices face nearly double the 5-10% average across other medical specialties, with an 18% claim denial rate. The primary reason isn’t incorrect Neurosurgery CPT codes or lack of medical necessity, but inadequate documentation. When operative reports miss critical details about procedures performed, or when medical records fail to justify why surgery was necessary, insurance […]
Understanding DME HCPCS Codes: The Key to Accurate Medical Equipment Billing
When you hear the term DME HCPCS Codes, it refers to a standardized set of codes used to describe durable medical equipment (DME), supplies, and non‑physician services for billing and insurance claims. The acronym HCPCS stands for Centers for Medicare & Medicaid Services (CMS)’ Healthcare Common Procedure Coding System. The “DME” part indicates that these […]
Pediatric CPT Codes Breakdown by Age Groups
Age-specific errors in pediatric CPT codes cost practices thousands monthly, yet they’re completely preventable once you know the exact cutoffs. Bill a five-year-old’s checkup with an infant code, and watch your claim get rejected within 48 hours. Use 99382 instead of 99383 for that same visit, and you’ve just underbilled by $30. Pediatric billing and […]
What Providers Need to Know About the QZ Modifier?
The use of the QZ modifier by Certified Registered Nurse Anesthetists (CRNAs) has grown significantly in recent years. Between 2000 and 2014, the percentage of anesthesia claims under Medicare using the modifier QZ increased from 10.9% to 21.7%. This shift reflects changes in how anesthesia services are delivered and billed, with anesthesia services accounting for […]
A Complete Physician Guide to Professional vs Institutional Claims
Across the U.S., physicians lose revenue every year because claims are sent with the wrong type, wrong form, or missing details. Much of this starts with confusion about professional vs institutional claims. When professional claims and institutional claims are mixed up, payers deny or delay payment. This guide explains institutional vs professional claims step by […]
How do Specialized Outsourced Billing Services Help CHCs?
Did you know that Community Health Clinics (CHCs) face some of the highest rates of claim denials and delayed payments in the healthcare system? In fact, about 20% of claims are rejected the first time they’re submitted, leading to months of back-and-forth just to get paid. That’s a huge problem, especially when clinics are already […]
Texas Law on Unpaid Medical Bills: What You Need to Know About Debt Collection and Your Rights
Medical debt remains a significant challenge for both patients and healthcare providers, particularly when billing delays or collection issues occur. For providers in Texas, understanding the Texas laws on unpaid medical bills is essential to staying compliant and protecting revenue. There are three key Texas laws that every provider should be aware of: the timely […]
Why Your Hospital Is Losing Money on Nursing Home Billing?
You discharge a patient to a nursing home. You think everything is fine. Then three months later, you get a denial. Or worse, you never get paid at all. This happens every day in hospitals across the country. And it’s costing you serious money. Let’s talk about why this keeps happening. And what you can […]
Ambulatory Surgery Center Coding Compliance Checklist for 2026
The ambulatory surgery center coding can be complicated, particularly amid the constantly changing payer regulations, changes in coding, and reimbursement plans in 2026. Compliance and reimbursement maximization demand more than merely learning the basics as a healthcare practitioner, administrator, and coder; it will demand vigilance, accuracy, and flexibility. In this blog, we have developed an […]
How to Improve OBGYN Medical Billing for Better Financial Health and Cash Flow?
Every dollar your OB/GYN practice should be collecting is worth fighting for because when OBGYN medical billing breaks down, everything else does too. Cash flow stalls, staff burn out on appeals and paperwork, and patient trust frays when bills arrive late or wrong. If you’re tired of watching services you provided turn into denied claims, […]