Medical Billing & RCM Insights for US Practices

Practical notes on denials, coding and credentialing, written by the people who do the work. We publish when we have something worth saying, not to fill a calendar.

MEDICAL BILLING Clean claims in medical billing guide showing the clean claim rate formula, benchmarks, common errors and a pre-submission checklist

Clean claims in medical billing guide showing the clean claim rate formula, benchmarks, common errors and a pre-submission checklist

Clean Claims in Medical Billing: What They Are, Why Practices Miss the Mark, and How to Fix It

What makes a claim clean, how it differs from a rejected or denied claim, the clean claim rate formula and 95% benchmark, the 12 errors that make claims dirty, a pre-submission checklist, and what a scrubber can and cannot catch...

MEDICAL BILLING Clearinghouse rejections in medical billing guide showing rejection vs denial, 999 and 277CA reports and the most common rejection causes

Clearinghouse rejections in medical billing guide showing rejection vs denial, 999 and 277CA reports and the most common rejection causes

Clearinghouse Rejections in Medical Billing: Causes, Fixes and Prevention

A rejection is not a denial, but the filing clock keeps running. Rejection vs denial, the three gates a claim has to pass, how to read the 999 and 277CA, the ten most common rejection causes, and a daily workflow that keeps them from piling up...

MEDICAL CODING Oppositional defiant disorder ICD-10 code F91.3 guide with DSM-5-TR criteria, DMDD and conduct disorder differences and documentation rules

Oppositional defiant disorder ICD-10 code F91.3 guide with DSM-5-TR criteria, DMDD and conduct disorder differences and documentation rules

Oppositional Defiant Disorder ICD-10 Code: F91.3 Coding and Billing Guide

F91.3 is billable as-is, but the neighbors cause the denials. The F91 family, DSM-5-TR criteria and severity specifiers, why F91.3 and F34.81 never share a claim, coding with ADHD, symptom codes before confirmation, and the CPT codes paired with ODD...

MEDICAL BILLING Urology medical billing guide covering CPT and ICD-10 coding, the 2026 prostate biopsy code change, modifier 25 vs 57 and denial prevention

Urology medical billing guide covering CPT and ICD-10 coding, the 2026 prostate biopsy code change, modifier 25 vs 57 and denial prevention

Urology Medical Billing: The Complete Guide to Coding, Modifiers and Denial Prevention

The code families urology bills most, ICD-10 specificity that wins medical necessity, the 2026 prostate biopsy overhaul (55700 to 55707-55715), Aquablation's new code, the site-of-service fee shift, modifier 25 vs 57, and a clean-claims workflow...

MEDICAL BILLING Type of bill 111 guide showing the UB-04 hospital inpatient admit-through-discharge code, frequency digits and common billing errors

Type of bill 111 guide showing the UB-04 hospital inpatient admit-through-discharge code, frequency digits and common billing errors

Type of Bill 111: What It Means and How to Bill It Correctly

The UB-04 code for a complete hospital inpatient stay: how the three digits break down, 110 vs 111 vs 117 vs 118, 111 vs 131 and 851, the fields that must agree, Medicare's 3-day window, FY 2027 IPPS rates and the errors that cost hospitals...

MEDICAL BILLING Post payment in medical billing guide covering payment posting steps, ERA and CARC codes, reconciliation and post-payment audits

Post payment in medical billing guide covering payment posting steps, ERA and CARC codes, reconciliation and post-payment audits

Post Payment in Medical Billing: How to Post, Reconcile and Protect Every Payment

A payment in the bank is not revenue until it is posted and reconciled. The nine-step posting workflow, a worked claim that balances to zero, the CARC codes you post daily, manual vs auto-posting, post-payment audits and Medicare's 60-day rule...

MEDICAL CODING Dilation and curettage CPT code 58120 billing guide with obstetric alternatives, hysteroscopy bundling, modifiers and 2026 Medicare rates

Dilation and curettage CPT code 58120 billing guide with obstetric alternatives, hysteroscopy bundling, modifiers and 2026 Medicare rates

Dilation and Curettage CPT Code: The Complete 58120 Billing Guide

58120 is nonobstetrical only. The obstetric codes for miscarriage (59812, 59820, 59821), 58120 vs 58100 vs 57505, why 58558 absorbs the D&C, the 10-day global, ICD-10 pairings, 2026 Medicare rates and the "58121" myth...

MEDICAL CODING 40 ridiculous ICD-10 codes that are actually real, including struck by turtle, sucked into jet engine and spacecraft accidents

40 Ridiculous ICD-10 Codes That Are Actually Real

Struck by turtle, sucked into a jet engine (twice), spacecraft collisions, a prison swimming pool as place of occurrence: 40 real codes sorted by category, why each one exists, and what the 7th character actually means...

DENIAL MANAGEMENT CO-45 denial code guide showing the contractual obligation adjustment, CO-45 vs PR-45, appeal deadlines and the 2026 Medicare fee schedule update

CO-45 denial code guide showing the contractual obligation adjustment, CO-45 vs PR-45, appeal deadlines and the 2026 Medicare fee schedule update

CO-45 Denial Code: What It Means and How to Resolve It in 2026

CO-45 is a contractual write-off, not a patient balance. The CO vs PR distinction, a worked EOB example, seven real causes, the four-step check before posting, appeal windows by payer, and the 2026 Medicare conversion factor change...

MEDICAL BILLING Revenue code 360 medical billing guide showing operating room services on the UB-04, the 036X family and common denial reasons

Revenue Code 360 in Medical Billing: What It Means and How to Bill It Right

0360 bills for the operating room, not the surgeon. The official 036X family, the codes it gets confused with (0361, 0370, 0710, 0490), the OR documentation payers expect, five denial patterns, and a seven-step billing workflow...

MEDICAL CODING CPT code for cystoscopy guide showing the 52000 to 52352 code family, modifiers, ICD-10 pairings and NCCI bundling edits

CPT Code for Cystoscopy: Complete Billing and Coding Guide

Every cystoscopy code from 52000 to 52352 grouped by procedure, the "separate procedure" rule behind most denials, tumor-size code selection, modifiers 51 and 59, ICD-10 pairings, NCCI bundling, and a documentation checklist...

MEDICAL BILLING Revenue code 636 billing guide showing drugs requiring detailed coding, HCPCS and NDC rules, OPPS status indicators and the 636 vs 250 comparison

Revenue code 636 billing guide showing drugs requiring detailed coding, HCPCS and NDC rules, OPPS status indicators and the 636 vs 250 comparison

Revenue Code 636: The Complete Guide to Billing, Reimbursement, and Avoiding Denials

Pharmacy drugs requiring detailed coding: inpatient vs outpatient rules, the hemophilia clotting factor exception, 2026 OPPS status indicators and the $140 threshold, 636 vs 250, a UB-04 field walkthrough, and NDC formatting...

MEDICAL BILLING Revenue code 0250 pharmacy billing guide showing the 025X family, HCPCS and NDC pairing, Medicare OPPS packaging and JW and JZ modifiers

Revenue code 0250 pharmacy billing guide showing the 025X family, HCPCS and NDC pairing, Medicare OPPS packaging and JW and JZ modifiers

Revenue Code 0250: Pharmacy Billing Guide, Fee Schedules, and Denial Fixes

0250 marks the pharmacy department, not the drug. How it pairs with HCPCS and NDC codes, the 025X family, Medicare packaging and ASP+6% rules, Medicaid NDC requirements, JW/JZ modifiers, and the denial fixes hospitals need...

MEDICAL CODING Tick bite ICD-10 code guide showing site-specific injury codes paired with W57.XXXA, Lyme disease codes and tick removal CPT codes

Tick Bite ICD-10 Code: The Complete Coding and Billing Guide

There is no single tick bite code. The site-specific S-code and W57.XXXA pairing, every body-part code by encounter type, unspecified-site fallbacks, Lyme and tick-borne illness codes, and the CPT rules for tick removal...

MEDICAL BILLING What is a superbill in medical billing guide showing required fields, CPT and ICD-10 codes and the out-of-network reimbursement process

What is a superbill in medical billing guide showing required fields, CPT and ICD-10 codes and the out-of-network reimbursement process

What Is a Superbill in Medical Billing? Everything Providers and Patients Need to Know

What a superbill is, how it differs from a medical bill and a CMS-1500, the fields payers expect, the code mismatches that cause denials, and why credentialing status decides whether you need one at all...

MEDICAL CODING ICD-10 codes for EGD procedures guide showing ICD-10-CM diagnosis codes, screening vs diagnostic coding and CPT pairing

ICD-10 Codes for EGD Procedures: The Complete Billing Guide

Which ICD-10-CM diagnosis codes justify an EGD, when ICD-10-PCS applies, screening vs diagnostic coding with Z13.810, the right pairings for CPT 43235, 43239, 43255 and 43249, and the denial patterns to prevent...

MEDICAL CODING Funny ICD-10 codes list for 2026 including struck by orca, struck by duck and sucked into jet engine

50+ Funny ICD-10 Codes That Are Completely Real (2026 List)

Struck by orca, pecked by chicken, bizarre personal appearance: real codes from the 2026 set, why they exist, what changed in the FY2026 update, and the specificity lesson that protects your claims...

MEDICAL CODING Endometrial biopsy CPT code 58100 billing and coding guide with modifiers, ICD-10 pairing and 2026 reimbursement

Endometrial Biopsy CPT Code 58100: Complete Billing and Coding Guide

How 58100 differs from 58120 and 58558, the ICD-10 codes that prove medical necessity, modifier 25 and 59 rules, 2026 reimbursement factors, and the denial patterns OB-GYN practices see most...

MEDICAL CODING CPT code 99213 billing, documentation and MDM guide showing 2026 RVU rates, time thresholds and modifiers

CPT Code 99213: The Complete Billing, Documentation, and MDM Guide

The MDM and total-time pathways, how 99213 compares to 99212, 99214 and 99215, 2026 RVU values and Medicare rates, modifiers 25 and 95, and the undercoding habit costing practices revenue...

MEDICAL BILLING EMR vs EHR comparison guide showing the difference between electronic medical records and electronic health records

EMR vs EHR: What's the Real Difference (And Why It Affects Your Revenue Too)

An EMR is a digital chart for one practice. An EHR travels with the patient. See how that one difference shapes coding accuracy, denial rates, credentialing, prior authorizations and patient collections...

MEDICAL CODING CPT code 52000 diagnostic cystourethroscopy billing guide showing 2026 Medicare rates, modifiers and ICD-10 pairs

CPT Code 52000: Description, Cost & Billing Rules

Diagnostic cystoscopy billing explained: 2026 Medicare rates, why "separate procedure" blocks unbundling, which ICD-10 codes earn the claim, and the modifiers that trigger denials...

MEDICAL CODING EGD CPT code list 2026 showing diagnostic and therapeutic upper endoscopy codes from 43235 to 43270

EGD CPT Code List 2026 Complete Billing Guide

Every EGD CPT code from 43235 to 43270, with the dilation and biopsy distinctions, modifier rules, and NCCI bundling edits that separate a clean claim from a denial...

COMPLIANCE & AUDITS Medicare 8-minute rule chart showing total timed minutes converted to billable therapy units

Medicare 8-Minute Rule Explained: 2026 Chart, Formula, and Billing Examples

One miscounted minute can cost a therapy practice a billable unit. The 2026 unit chart, the total time formula, mixed remainder examples, the AMA Rule of Eights comparison and the KX modifier thresholds...

CREDENTIALING Provider credentialing and its impact on practice revenue

How Provider Credentialing Impacts Practice Revenue

Credentialing determines when providers can see covered patients, submit payable claims and protect cash flow. Learn the revenue risks and workflow controls that prevent avoidable delays...

MEDICAL CODING HCPCS code J3490 injectable drug billing guide

HCPCS Code J3490: Billing, Documentation, and Reimbursement Guide

J3490 is used for unclassified drugs, but it still requires precise product, dosage, unit and medical-necessity documentation. Review common denial causes and billing checks...

REVENUE CYCLE Improving patient collections in a healthcare practice

How to Improve Patient Collections: 12 Best Practices for Healthcare Practices

Most practices lose 5 to 15% of earned revenue to denied claims, aging AR and unpaid patient balances. Here are 12 fixes across the full revenue cycle, with KPI benchmarks...

REVENUE CYCLE Medical billing and claims processing

Why Your Medical Claims Keep Getting Denied: 7 Common Mistakes and How to Fix Them

Claim denials tie up revenue you have already earned. Learn the seven most common reasons payers reject claims and the exact fix for each one...

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