Medicare made the behavioral health telehealth basics permanent. The rest of the flexibilities run to the end of 2027. Here is how the place of service code, the modifier and the payer decide whether the visit pays.
The good faith estimate is narrower than most practices assume. It goes to uninsured and self-pay patients only, it runs on business days, and a bill $400 above it can be taken to federal dispute resolution.
A same-day visit and a procedure can both pay. What decides it is whether the note shows two pieces of work, and the OIG's audit of same-day E/M services billed with modifier 25 found that mostly it did not.
Credentialing approves the clinician. Contracting sets the money. Most of the questions your billing team asks live in a provider manual or a fee schedule addendum rather than in the contract, and when the contract is silent you have to ask in writing. Here is what to ask for, and what to do when no one answers.
Medicare pays second only when the facts put it there. Here is how the working aged, disability, ESRD, no-fault, liability and workers' compensation situations are decided, and what happens when the order goes wrong.
It is the one revenue cycle number that resists being dressed up, because the denominator only counts the dollars a payer contract said you could keep. Here is the formula, the three ways it goes wrong, and how to read it month to month.
A medical necessity denial is the payer applying a rule to your record. Here is how to get that rule in writing, tie each element of it to a line in the chart, and file at the level that owns the decision.
A working reference for the revenue cycle KPIs US practices report, with the formula in words, the mistake that makes each number misleading, and the organisation that owns every benchmark quoted.
An authorization that does not match the claim that was billed is worth about as much as no authorization at all. Here is the field list, the states that need a person, and the weekly reconciliation that catches the mismatch before the payer does.
