MedPrecision Operations Team
Revenue Cycle Operations (collective byline)
Articles under this byline reflect the working knowledge of the MedPrecision RCM operations team — AAPC-certified coders and billers with 10+ years of combined medical billing experience across multiple specialties. This is a collective operational byline, not a single individual. For attributable expert commentary or to speak with a named team member for press, contact info@medprecisionbilling.com.
Articles by MedPrecision Operations Team
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Cardiology Denial Cheat Sheet: Top CARC Codes, Causes, Fixes, and Appeal Angles
The top cardiology billing denials by CARC code — cath-lab bundling (97/236), stress-test supervision, echo downcoding, prior auth (197) — each with the fix and appeal angle.
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Medical Billing Vendor Evaluation Scorecard: 27 Weighted Criteria to Score Before You Sign
A weighted 27-criterion scorecard to evaluate medical billing vendors. Score each 0/1/2, total out of 100, plus red-flag auto-disqualifiers and a worked example.
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Mental Health Billing Denials Cheat Sheet: CARC Codes, Causes, Fixes, and Appeal Angles
The top mental health billing denials in one reference: CARC code, plain-English cause, code/modifier context, the operational fix, and the appeal angle for each.
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Orthopedic Denial Cheat Sheet: Top CARC Codes, Causes, Fixes and Appeal Angles (2026)
The top orthopedic billing denials by CARC code — global-period 97, prior-auth 197, NCCI 236, info-missing 16 — each with the cause, modifier context, fix and appeal angle.
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Physical Therapy Denial Cheat Sheet: Top PT Denials by CARC Code, Cause, Fix, and Appeal Angle
The top physical therapy billing denials by CARC code — 97140+97530 bundling (CARC 97/236), missing GP/KX modifiers, auth gaps (197) — with the fix and appeal angle for each.
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Urgent Care Denial Cheat Sheet: Top CARC Denials, Causes, Fixes, and Appeal Angles
The top urgent care billing denials by CARC code — POS 20 vs 11, modifier 25 on procedure-bundled E/M, S-code routing, auth — with the fix and appeal angle for each.
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90834 vs 90837: Psychotherapy Billing, Time Rules & 2026 Rates
90834 bills 45-minute psychotherapy (38-52 min); 90837 bills 60 minutes (53+ min). See the 38-minute threshold, 2026 CMS rates, and how to defend 90837.
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ABA Billing Codes 97153 & 97155: Units, Rules & Denials (2026)
ABA CPT 97153 (technician treatment) and 97155 (QHP protocol modification): 15-minute units, concurrent-billing rules, auth tracking, and denial fixes.
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A/R Aging Report in Medical Billing: How to Read It and Work Every Bucket (2026)
An A/R aging report sorts unpaid claims by 0-30, 31-60, 61-90, 91-120, 120+ days. Target under 25% of A/R over 90. Bucket table, worked example, playbook.
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B7 Denial Code: Provider Not Certified for This Service — How to Fix It (2026)
B7 means the provider wasn't certified/eligible to be paid for this service on this DOS. Causes, the PECOS/credentialing fix, and a B7 vs CO-185 vs CO-8 table.
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BCBS Denial Codes List: BlueCard, Prefixes & How to Fix Each (2026)
BCBS denial codes map to standard X12 CARC/RARC values. Decoder tables for common Blue Cross Blue Shield denials, BlueCard routing, and the alpha-prefix fix.
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CO-129 Denial Code: What It Means and How to Fix It (2026)
CO-129 means prior processing info appears incorrect — usually a corrected claim filed without frequency code 7 or the right original claim number. The fix.
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CO-16 Denial Code: What It Means and How to Fix It (2026)
CO-16 means the claim lacks information needed for adjudication. The fix lives in the paired RARC. Decoder table for N822, M51, N290, N382 and how to fix each.
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CO-22 Denial Code: Coordination of Benefits — How to Fix It
CO-22 means care may be covered by another payer per coordination of benefits. Learn the COB-order causes, the bill-primary-first fix, and the appeal steps.
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CO-236 Denial Code: NCCI Compatibility Meaning & How to Fix It
CO-236 means a procedure/modifier combo is not NCCI-compatible. Learn the Modifier Indicator 0/1/9 fix, when to add modifier 59/X, and when to write off.
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CO-29 Denial Code: Timely Filing Limit Expired — How to Fix It
CO-29 means the time limit for filing the claim expired. See timely filing limits by payer, the exceptions that win appeals, and a copy-paste appeal template.
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CO-A1 Denial Code: What It Means and How to Fix It (2026)
CO-A1 means the claim/service is denied and at least one Remark Code must be provided. The real reason lives in the paired RARC. Decoder table + fix workflow.
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Colonoscopy CPT Codes 45378-45385: Screening vs Diagnostic Billing (2026)
45378 diagnostic, 45380 biopsy, 45384/45385 polyp removal, G0105/G0121 screening. Modifier 33 vs PT, the screening-turned-diagnostic cost trap, and denials.
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Dermatology Billing Benchmarks (2026): KPIs, Denial Rates & Targets
Dermatology billing benchmarks for 2026: clean claim rate, denial rate, days in A/R, and net collection rate bands, plus top derm CARC denials and fixes.
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G0438 vs G0439: Annual Wellness Visit Billing Guide (2026)
G0438 is the initial Medicare AWV (once per lifetime); G0439 is every subsequent AWV (annual). The difference, 2026 rates, vs IPPE G0402, and denial fixes.
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Home Health CPT & HCPCS Codes: The 2026 Billing Reference
Home health billing runs on HCPCS G-codes, not CPT — G0299/G0300, G0151-G0153, the PDGM 30-day claim, plus home E/M 99341-99350 and CPO. Full code table inside.
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Knee Arthroscopy Billing (29881, 29880, 27447): Codes, Modifiers & Denials (2026)
29881 (1-compartment meniscectomy) vs 29880 (2-compartment) vs 27447 (TKA). Modifier 50/RT/LT/59 rules, 90-day globals, CMS PFS rates & top denials.
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Medi-Cal Billing Guide: Managed Care, Share of Cost, TARs & Timely Filing (2026)
Medi-Cal billing explained: managed care vs fee-for-service, share of cost, TARs, the 6-month timely filing rule, and major Medi-Cal plans by region.
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N822 & N823 Remark Codes: Missing or Invalid Modifier — How to Fix
N822 means a missing procedure modifier; N823 means an invalid one. Learn the CO-16 + N822 fix, the modifier-by-specialty triggers, and how to resubmit.
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OB Global Package Billing: 59400, 59510, 59610 & When to Unbundle (2026)
OB global codes 59400 (vaginal), 59510 (cesarean), 59610 (VBAC) bundle antepartum, delivery & postpartum. Learn what's included, when to unbundle & code rates.
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PALTC Revenue Cycle Management: A 2026 Operating Guide (SNF, ALF, LTC)
PALTC RCM explained: SNF triple-check, PDPM/MDS, consolidated billing, Part A vs B, Medicaid room-and-board vs ancillary, plus 2026 KPI benchmark bands.
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Payment Posting in Medical Billing: ERA, Reconciliation & KPIs (2026)
Payment posting records every payment, adjustment, and denial against a claim. Learn ERA (835) vs manual EOB posting, reconciliation, and the accuracy KPI band.
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Podiatry CPT Codes Cheat Sheet: Routine Foot Care, Q Modifiers & Surgery (2026)
Podiatry CPT cheat sheet: routine foot care (11055-11057, 11719-11721, G0127), Q7/Q8/Q9 class-finding modifiers, at-risk dx coverage, and 28xxx surgical codes.
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POS 02 vs POS 10: Telehealth Place of Service Codes Explained (2026)
POS 10 is telehealth in the patient's home (higher non-facility rate); POS 02 is telehealth elsewhere (lower facility rate). Rate table, payer rules and fixes.
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POS 13 in Medical Billing: Assisted Living Facility Code Explained (2026)
POS 13 = Assisted Living Facility, paid at the non-facility rate. Who bills it, E/M codes 99341-99350, POS 12/14/31/32/33 compared, and common denials.
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PR-1, PR-2, PR-3 Patient Responsibility Codes: Deductible, Coinsurance & Copay Explained
PR-1 = deductible, PR-2 = coinsurance, PR-3 = copay. What each means, when to bill the patient, and when NOT. Side-by-side table plus the statement workflow.
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PR-227 Denial Code: What It Means and How to Fix It (2026)
PR-227 means info the payer requested from the patient wasn't provided. COB and other-insurance causes, how to get them to respond, plus PR-31 vs CO-16.
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PR-27 Denial Code: Expenses After Coverage Terminated — How to Fix It
PR-27 means expenses incurred after coverage terminated. The causes, the re-verify-and-rebill fix, PR-27 vs PR-26 vs CO-27, and an appeal template.
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PR-31 Denial Code: Patient Cannot Be Identified as Our Insured — How to Fix It
PR-31 / CARC 31 means the patient cannot be identified as the payer's insured. Learn the causes (wrong member ID, name mismatch, wrong payer) and the fix.
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PR-95 Denial Code: Plan Procedures Not Followed — How to Fix It
PR-95 means plan procedures not followed: missing referral, no prior auth, or out-of-network. Learn the fix, retro-auth, and when you can bill the patient.
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Specimen Handling 99000 & 99001 Billing: When It's Payable (2026)
CPT 99000 and 99001 bill specimen handling. Medicare bundles both (status B). See when commercial payers reimburse 99000, plus the 99000 vs 36415 table.
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UB-04 Revenue Codes Explained: FL 42, HCPCS Pairing & Common Codes (2026)
UB-04 revenue codes (FL 42) classify each charge by department. Common-codes table, how to pair HCPCS in FL 44, bill types in FL 4, and UB-04 vs CMS-1500.
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Urgent Care Billing Codes S9083 & S9088: Requirements, Rates & Denials (2026)
S9083 is a flat global case rate; S9088 is an add-on billed WITH an E/M. Learn which payers mandate each, POS 20 rules, and how to fix common denials.
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97 Denial Code Explained: What It Means and How to Fix It
CARC 97 means the service is bundled into another procedure. Learn what triggers it (NCCI PTP edits), the modifier 59/X-modifier fix, and when to appeal.
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Common CARC and RARC Codes: Denial Codes Reference
Reference list of the most common CARC and RARC codes used by payers, with one-line meaning and operational fix for each. Built for denial worklists.
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Medical Billing Denial Benchmarks 2026: Industry Data, Specialty Breakdowns, Top Denial Codes
Where your denial rate should land in 2026: MGMA/HFMA ranges by specialty, the CARC codes driving denials, and the gap between initial and final denial rates.
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Medical Billing vs Medical Coding: What's the Difference?
Coders translate documentation into ICD-10/CPT/HCPCS; billers turn codes into paid claims. Daily tasks, certifications, salaries, and how the roles differ.
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What Is a Superbill in Medical Billing?
A superbill is the itemized form a provider gives a patient or payer with CPT, ICD-10, and HCPCS codes. What's on it, when it's used, and how it differs from.
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The Benefits of Outsourcing Medical Billing in 2026 (Honest ROI Analysis)
Seven measurable benefits of outsourcing medical billing — quantified with worked ROI examples — plus four scenarios where keeping it in-house is the right.
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Best Medical Billing Companies (2026 Buyer's Guide)
Compare 2026 medical billing companies on pricing (4–9% of collections), specialty fit, and contract red flags — plus 14 questions to ask before you sign.
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Denial Management in Healthcare: Complete Guide with CARC Code Reference
Complete denial management guide: top 25 CARC codes with fixes, the 6-step workflow, appeal templates, and how practices drop denial rates below 5%.
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HIPAA Compliance in Medical Billing: Complete 2026 Guide for Practices and Vendors
HIPAA compliance for medical billing: BAA checklist, three rules (Privacy, Security, Breach Notification), minimum necessary standard, and how to vet a vendor.
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Hospital Billing vs. Professional Billing: Complete 2026 Comparison Guide
Hospital vs professional billing differences: UB-04 vs CMS-1500 forms, facility vs professional fees, DRG vs CPT reimbursement, and when both apply.
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How Much Do Medical Billing Companies Charge in 2026? Complete Pricing Guide
Medical billing pricing breakdown: percentage of collections (4-9%), per-claim ($4-$12), flat fees. Fair-market rates by specialty plus hidden fees to watch.
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The Medical Billing Process Step-by-Step (2026 Complete Guide)
The medical billing process from scheduling to final payment: 12 steps, the average time at each, what can go wrong with cost impact, and tuning each stage.
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Revenue Cycle Management Best Practices for 2026: The Complete Operational Playbook
10 revenue cycle management best practices for medical practices and hospitals — eligibility, charge lag, denial triage, A/R aging — plus a 90-day rollout plan.
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What Is A/R in Medical Billing? Days in A/R, Aging Buckets, and How to Manage Them
A/R in medical billing explained: days-in-A/R calculation, aging buckets (0-30, 31-60, 61-90, 90+), the collection probability curve, and how to keep A/R under.
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What Is RCM in Medical Billing? Complete 2026 Guide to Revenue Cycle Management
Revenue cycle management (RCM) explained: 12 stages from scheduling to write-off, the 6 KPIs that matter, common failure points by stage, and what good looks.
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CAQH ProView Credentialing Guide (2026)
How CAQH ProView works, what providers must keep current, the 120-day attestation cycle, and the common credentialing failures that hold up payer enrollment.
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Appeal Letter Template for Medical Billing (with Examples)
How to write a medical billing appeal letter that wins: required elements, three sample templates by denial type (CARC 50, 197, 97), and payer appeal levels.
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Physical Therapy CPT Codes: Cheat Sheet & Reimbursement Reference
Physical therapy CPT codes reference. Eval 97161-97164, treatment 97110/97112/97140/97530, modalities, 8-Minute Rule math, and KX modifier triggers.
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Chronic Care Management Billing (CPT 99490): The Complete Rules
CPT 99490 Chronic Care Management requirements: two chronic conditions, 20 minutes monthly, the consent rule, the care plan, and related codes 99439, 99487,.
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The Prior Authorization Process Explained (2026)
How prior authorization works end-to-end: payer requirements, the 278 transaction, CMS Final Rule timelines, common denials (CARC 197), and operational steps.
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Electronic Claim Submission vs Paper: The Real Comparison
Why electronic claim submission via X12 837 beats paper CMS-1500: HIPAA standards, the ASCA rule, processing time differences, and when paper still applies.
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Medical Billing KPI Dashboard Template (2026)
The 12 KPIs every billing dashboard should track, formulas, HFMA targets, and the dashboard layout that surfaces problems before they become revenue losses.
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Provider Enrollment Checklist (2026): Every Document You Need
Provider enrollment checklist: 32 documents needed for Medicare, Medicaid, and commercial payer enrollment, organized by category with verification.
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How to Choose a Medical Billing Company
Choosing the right medical billing company is critical for your practice. Learn what to evaluate, questions to ask, and red flags to avoid with this guide.
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How to Improve Clean Claim Rate
A high clean claim rate means faster payments and fewer denials. Learn actionable strategies to improve your first-pass claim acceptance rate with MedPrecision.
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How to Recover Aged A/R
Aged A/R collection probability drops below 50% past 90 days, below 30% past 120. Recovery workflow: triage, payer escalation, and the appeal queue.
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How to Reduce Claim Denials
Claim denials cost practices 5-10% of revenue. Five-step prevention workflow with the front-end checks, coding rules, and KPIs that drop denial rate below 5%.
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How to Switch Medical Billing Companies Without Revenue Loss
Step-by-step guide to switching your medical billing company without disrupting cash flow. Avoid the common mistakes that cause revenue gaps during transitions.
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Medical Billing for Group Practices
Discover how group practices can improve revenue cycle performance, reduce overhead, and improve collections with MedPrecision's specialized billing services.
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Medical Billing for Multispecialty Practices
Multispecialty billing requires per-specialty coders, separate fee schedules per payer-specialty, and KPI dashboards by department. The operational playbook.
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Medical Billing for New Practices
Starting a new practice? The 90-day medical billing playbook: credentialing timeline, payer enrollment, fee schedules, software, and cash forecast.
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Medical Billing for Telehealth Providers
Telehealth billing in 2026: POS 02 vs POS 10, modifier 95 rules, audio-only codes (G2025), payer parity status, and the documentation that survives audit.
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Outsource Insurance Eligibility Verification
30-40% of front-end denials are eligibility-related. Outsourced verification: pricing, workflow, vendor evaluation, and break-even math for practices.
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Outsource Prior Authorization
AMA data: practices spend 13 hours/week per physician on prior auth. Outsourcing PA: typical pricing, ROI math, vendor evaluation criteria, and risks to manage.
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RCM Outsourcing vs Internal Team
RCM outsourcing (4-9% of collections) vs an internal team (8-14% fully loaded): the cost math, KPI gaps, and the four scenarios where internal RCM still wins.
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What PT Practices Should Check Before Outsourcing Billing
PT practices face therapy caps, KX modifier rules, and 11% denial rates. The 12 things to evaluate and fix before outsourcing your physical therapy billing.
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Why Mental Health Practices Lose Revenue in Billing
Mental health practices lose 8-12% of revenue to credentialing gaps, auth errors, and coding mistakes. The patterns — and the fixes that recover the money.
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Medical Billing Audit Checklist (2026): 47 Items to Review
47-item billing audit checklist: coding accuracy, documentation, denial trends, KPIs, compliance, and revenue leak detection — the first-engagement framework.
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Payer Credentialing Timeline and Cost (2026)
Credentialing timelines by payer (Medicare 30-60 days, commercial 90-180 days), the cost, typical effective dates, and steps that compress the process.
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Clean Claim Rate Formula and Target Benchmark (2026)
How to calculate clean claim rate the right way, the HFMA MAP Keys benchmark, what counts as 'clean,' and the 9 process levers that move CCR from 88% to 97%.
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Clearinghouse Rejection vs Payer Denial: The Critical Distinction
Why clearinghouse rejections are not denials, what happens to each, why timely filing implications differ, and how the 277CA tells the difference.
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Transitional Care Management Billing (CPT 99495 and 99496)
CPT 99495 and 99496 explained — the 2/7/14-day TCM contact rules, 2026 reimbursement rates, documentation traps, and why TCM claims get denied. Full guide.
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Days in A/R: Formula, Benchmark, and How to Reduce It
How to calculate days in A/R, where the MGMA/HFMA benchmark really sits by specialty, aging-bucket targets, and the four levers that bring your number down.
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Net Collection Rate vs Gross Collection Rate: The Real Difference
Why gross collection rate misleads, why net collection rate is the true performance metric, the formulas, the HFMA target, and how to compute both correctly.
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ERA vs EOB: The Real Difference Explained
ERA (X12 835 electronic remittance) vs EOB (patient explanation of benefits) — what each contains, who receives them, and why providers should rely on ERA.
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EFT vs Paper Check Payer Payments: Why Every Practice Should Convert
How payer EFT works, the CAQH CORE EFT and ERA operating rules, the days-saved versus paper check, and the steps to enroll every payer in EFT.
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