Denial Appeal Letter Templates: What to Include in Each One
A working set of appeal letters by denial family, with the CARC to expect, the evidence to attach, the level the request belongs to, and the deadline that decides it.
Charge Capture Leakage: Where Practices Lose Money Quietly
Denials announce themselves. Missed charges do not. Here is where care that was delivered stops short of a claim, and the reconciliation that catches each stop.
Radiology Billing: Professional vs Technical Components
One imaging code, two payments. Here is what the professional and technical components actually cover, which modifier bills which half, how CMS decides which codes can split at all, and what the anti-markup rule does to a study you buy from an outside supplier.
Payer Enrollment: What to Do When a Contract Is Silent
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 Secondary Payer Rules: Getting the Order Right
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.
Revenue Cycle KPIs: Definitions, Formulas and Benchmarks
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.
Prior Authorization Tracking: A System That Does Not Slip
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.
Qualifying Payment Amount: Why It Sets the Floor
The qualifying payment amount is a 2019 median the plan indexes forward with consumer inflation. That is why it lags the market, why it caps patient cost sharing, and why it is only one factor an arbitrator weighs.
Modifier Cheat Sheet for Medical Billing: The 20 That Matter
The 20 medical billing modifiers that decide whether a line pays, denies or gets bundled, with the payment percentage and the CMS source listed beside each one.