Revenue Cycle Optimization resources
How to measure, audit, and improve the revenue cycle -- from KPIs to full billing audits -- so you catch leaks before they compound.
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.
Read the Guide arrow_forwardABA 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.
Read the Guide arrow_forwardChronic 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,.
Read the Guide arrow_forwardColonoscopy 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.
Read the Guide arrow_forwardEFT 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.
Read the Guide arrow_forwardElectronic 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.
Read the Guide arrow_forwardERA 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.
Read the Guide arrow_forwardG0438 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.
Read the Guide arrow_forwardG2211 Add-On Code Explained: When and How to Bill It
G2211 (visit complexity inherent to E/M) — what CMS covers, when it applies, the documentation that supports it, and the 2024 activation for primary care.
Read the Guide arrow_forwardHome 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.
Read the Guide arrow_forwardHospital 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.
Read the Guide arrow_forwardKnee 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.
Read the Guide arrow_forwardMedical 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.
Read the Guide arrow_forwardOB 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.
Read the Guide arrow_forwardPALTC 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.
Read the Guide arrow_forwardPayment 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.
Read the Guide arrow_forwardPhysical 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.
Read the Guide arrow_forwardPodiatry 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.
Read the Guide arrow_forwardRevenue 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.
Read the Guide arrow_forwardSpecimen 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.
Read the Guide arrow_forwardThe 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.
Read the Guide arrow_forwardTransitional 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.
Read the Guide arrow_forwardUB-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.
Read the Guide arrow_forwardUrgent 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.
Read the Guide arrow_forwardWhat 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.
Read the Guide arrow_forwardWhy 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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