A clearinghouse eligibility check answers half of what a front desk needs and none of the questions that cause the biggest denials. Here are the ten things to confirm before a visit, and which source owns each answer.
The hard therapy cap was repealed in 2018, but the annual threshold that replaced it still decides whether a claim pays. Here is what the KX modifier, the plan of care, and the assistant modifiers actually require in 2026.
ABA billing runs on the 15-minute unit and a payer authorization that names its own unit count and rendering provider. Here is the code set, the unit rules, and the mismatches that turn a clean claim into a denial.
The dispute over an out-of-network payment starts long before the remittance arrives. Here is what belongs in the claim file, what a payer's remittance must carry under the 2026 No Surprises Act rules, and how to route a denial to the right track.
One calendar year from the date of service, no grace period, and four exceptions that each need documentation before a contractor will look at the claim. Here is what the clock actually measures, what the appeals process expects, and the internal deadlines that keep claims from aging into a write-off.
The FY 2027 code set is already live. Here is how the annual ICD-10 cycle is scheduled, where the official files publish, and the system-by-system checklist that keeps a practice from billing a retired code.
The stages a practice really waits through, who owns each clock, and which timeline numbers payers and CMS publish versus the ones nobody owns.
A healthy aging report is front-loaded: most of the money in the current to 30 day bucket, and almost nothing past 120. Here is what each bucket means, how the 90-plus tail drives days in A/R, and the action every layer calls for.
Denial volume keeps climbing on the payer side. A workflow that holds up assigns every denial to a named owner, starts the appeal clock the day the remittance posts, and writes off only what cannot be recovered.
