Orthopedic Prior Authorization: Denial Data, CMS Rules & Fixes
In a review of more than 7,000 elective spine surgery recommendations at one private orthopedic practice, insurers initially denied coverage for nearly 7% of patients. More than four in five of those patients had the surgery anyway, after a delay. That pattern, a denial followed by the same surgery later, shows why prior authorization challenges […]
Electrophysiology (EP) Billing Services for Ablations, Device Implants & Interrogations
The complete 2026 coding playbook for the highest-revenue, most bundling-dense subspecialty in cardiology: ablations, CIED implants, and the recurring interrogation codes that keep an EP program paid. Electrophysiology is the highest-revenue, lowest-volume corner of cardiology billing, and the most punishing from a billing standpoint. A single EP encounter can fold a diagnostic study, 3D mapping, […]
HME vs. DME Billing: Key Differences and CMS Rules
The two terms HME (Home Medical Equipment) and DME (Durable Medical Equipment) are used interchangeably. From a payer’s perspective, both terms are different and incorrect billing leads to claim denials. So, dealing with HME vs DME, it is essential to know that both DME and HME billing are different from each other. This article discusses […]
EOB vs ERA: What is the Difference in Healthcare?
The EOB vs ERA confusion is not new in the healthcare industry. Let’s bust this confusion with this detailed guide. When the claims are processed, two different documents are generated. The billing staff use these names interchangeably and the constant confusion never ends. EOB (Explanation of Benefits) is what the payer sends the patient and […]
In-House vs Outsourced ASC Billing: ROI Comparison for Surgery Centers
Every surgery center eventually runs the same math. Whether to handle ASC billing in-house or hand it out to a specialist company and pay a percentage of the collections. This guide lays out the cost structure on both sides and gives you a break-even model you can run with your own case volume, specialty mix, […]
Common Hospice Codes for Every Level of Care
There are four code families that run hospice billing. The first one is revenue codes that identify the level of care and the second is HCPCS Q-codes that identify where care was delivered. As for the third, it includes CPT and G-codes for physicians and the last are ICD-10 codes for the terminal diagnosis. If […]
Hospice Modifiers for Medicare: GV vs. GW Modifier Explained
When a patient chooses the Medicare hospice benefit, the standard Part B rules implication stops. Medicare straight up denies claims submitted without a GV or GW modifier (condition code 07) during the process of hospice election. This is assigned as provider liability which means you cannot bill the patient anymore. The GV modifier is for […]
Mastering Medicare Compliance: A Guide to Modifiers GA, GX, GY, and GZ
When billing under Medicare, a mistake at any level can be quite disruptive, making financial liability protections a difficult issue for healthcare administrators and revenue cycle leaders. If a provider performs a service that could be denied by Medicare, a modifier accompanies it. GA, GX, GY, and GZ are four of these modifiers that inform […]
What is Retro Authorization in Medical Billing?
The standard practice in medical billing is getting the payer’s approval before delivering a service. This is called prior authorization but clinical reality doesn’t always follow administrative timelines and emergencies happen. Coverage lapses go undetected and authorization requests sometimes aren’t completed. So in such cases, retro authorization is the next obvious thing a provider does […]
POS 22 in Medical Billing: Complete Guide to Outpatient Hospital Billing, Reimbursement & Compliance in 2026
Healthcare reimbursement depends heavily on accurate Place of Service (POS) coding. A single POS coding error can significantly impact reimbursement rates, trigger payer audits, delay claim processing, and increase denial rates. Among the most frequently misunderstood POS codes is POS 22, which identifies services performed in a hospital outpatient setting. As healthcare systems continue expanding […]