Orthopedic Surgery Billing Guide: Fracture Care, Arthroplasty, Arthroscopy CPT Codes, Global Periods, and Orthopedic RCM
Orthopedic surgery billing covers fracture care codes with 90-day global periods...
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84 articles matching “billing guide”.
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Population Health and Value-Based Care Billing Guide: CCM, TCM, AWV, and VBC RCM
Population health billing covers chronic care management codes 99490-99491 and 99439-99437 with consent and time documentation requirements, transitional care management 99495-99496 post-discharge 2-business-day contact and face-to-face...
Neonatology and Pediatrics Billing Guide: Newborn Care, NICU Codes, Well-Child Visits, and Pediatric RCM
Neonatology and pediatrics billing covers newborn hospital care codes 99460-99463, NICU neonatal critical care 99468-99469 and continuing intensive care 99477-99480 stratified by birth weight with common birth weight coding error explana...
Nursing Home and Long-Term Care Billing Guide: SNF E&M Codes, MDS, and LTC RCM
Nursing home and long-term care billing covers nursing facility E&M codes 99304-99318 for initial, subsequent, annual, and discharge care, Medicare Part A SNF PPS and PDPM payment model with MDS 3.0 assessment scheduling, consolidated bi...
Inpatient Psychiatric Billing Guide: Hospital E&M, Psychotherapy Add-Ons, and Behavioral Health RCM
Inpatient psychiatric billing covers hospital E&M codes 99221-99233 combined with psychotherapy add-on codes 90833-90836-90838 with documentation requirements for separately delineated E&M and psychotherapy components, psychiatric diagno...
Urgent Care Billing Guide: E&M Level Selection, Facility vs. Office Coding, and Urgent Care RCM
Urgent care billing covers E&M level selection 99202-99215 using medical decision making complexity criteria, place of service POS 11 office vs. POS 20 urgent care facility and its reimbursement impact, procedure coding for laceration re...
Obstetrics and Gynecology Billing Guide: Global OB Package, GYN Procedures, and OB/GYN RCM
OB/GYN billing covers global obstetric package codes 59400 vaginal delivery and 59510 cesarean with bundled antepartum, delivery, and postpartum care, antepartum-only codes 59425-59426 and delivery-only codes 59409-59514 for split care a...
Nephrology and Dialysis Billing Guide: ESRD Monthly Capitation, Dialysis Procedure Codes, CKD Management, and Nephrology RCM
Nephrology and dialysis billing covers ESRD monthly capitation payment codes 90951-90970 by patient age and face-to-face visit frequency, hemodialysis procedure codes 90935-90937 for acute inpatient settings, peritoneal dialysis 90945-90...
Hospitalist and Inpatient Billing Guide: Hospital E&M Codes, Critical Care, Observation, and Hospitalist RCM
Hospitalist and inpatient billing covers initial hospital care E&M codes 99221-99223 MDM-based level selection, subsequent hospital care 99231-99233, critical care time-based billing 99291-99292 with documentation requirements for critic...
Palliative Care Billing Guide: Advance Care Planning, Hospice vs. Palliative Care Billing, and Palliative Care RCM
Palliative care billing covers advance care planning CPT codes 99497-99498 with same-day AWV billing rules, palliative care E&M coding for complex symptom management using High MDM or total time, the distinction between palliative care E...
Radiation Oncology Billing Guide: Treatment Planning, IMRT, SBRT, Brachytherapy, and Radiation Oncology RCM
Radiation oncology billing covers treatment planning CPT codes 77261-77295 by complexity level, IMRT planning 77301 and delivery codes 77385 simple vs. 77386 complex for VMAT, SBRT per-fraction delivery 77373 and per-course management 77...
Hematology and Oncology Billing Guide: Chemotherapy Administration, Oncology E&M, Drug Billing, and Heme-Onc RCM
Hematology oncology billing covers chemotherapy administration CPT hierarchy 96413-96417 with sequential add-on 96417 and concurrent 96416, cancer drug HCPCS J-code billing with NDC numbers and Modifier JW for single-dose vial wastage an...
Orthopedic Billing Guide: Joint Replacement, Arthroscopy, Fracture Care, Sports Medicine, and Orthopedic RCM
Orthopedic billing covers total joint replacement 90-day global period management for THA 27130 TKA 27447 and TSA 23472, arthroscopy CPT codes 29800-29999 with NCCI bundling rules and add-on code requirements, fracture care coding by ope...
Allergy and Immunology Billing Guide: Allergy Testing, Immunotherapy, IVIG, and Allergy RCM
Allergy and immunology billing covers percutaneous allergy testing CPT 95004 and intradermal testing 95024 billed per allergen test, allergen immunotherapy split billing between preparation 95165 per dose and injection administration 951...
Infusion Center Billing Guide: Drug Administration Codes, Infusion Hierarchy, Drug HCPCS Billing, and Infusion RCM
Infusion center billing requires mastery of drug administration hierarchy rules with one initial code per encounter and sequential add-on codes 96367 and concurrent add-on 96368, therapeutic infusion CPT codes 96365-96368 vs. chemotherap...
Medicare Advantage Billing Guide: MA Plan Requirements, Prior Authorization, Star Ratings, and Medicare Advantage RCM
Medicare Advantage billing differs fundamentally from traditional Medicare: MA plans have their own fee schedules, prior authorization requirements for services traditional Medicare never requires PA for, HCC risk adjustment coding requi...
Ambulatory Surgery Center Billing Guide: ASC Payment System, Covered Procedures, and ASC Revenue Cycle
Ambulatory surgery center billing covers Medicare ASC payment system at 65.6% of OPPS APC rates with packaged services and device-intensive procedure offsets, covered vs. excluded procedures on the ASC covered procedures list, UB-04 faci...
Pediatric Billing Guide: Well-Child Visits, Vaccines, EPSDT, CHIP, and Pediatric Revenue Cycle
Pediatric billing involves well-child visit preventive care codes age-banded from infant through adolescent, vaccine administration CPT codes 90460 and 90471 with HCPCS product codes and VFC program billing, EPSDT mandatory Medicaid cove...
Auto Insurance and Personal Injury Medical Billing Guide: No-Fault, PIP, MedPay, and Lien-Based Billing
No-fault PIP billing with state-specific fee schedules and 30-day timely filing requirements, MedPay coordination with health insurance for accident-related treatment, letter of protection (LOP) lien-based billing for personal injury pat...
Hospice Billing Guide: Medicare Hospice Benefit, Levels of Care, and Hospice Revenue Cycle
Medicare hospice eligibility criteria including six-month prognosis certification and hospice election statement, four levels of hospice care billing including Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General...
Skilled Nursing Facility (SNF) Billing Guide: Medicare PDPM, RUG-IV, and SNF Revenue Cycle
Medicare Part A SNF coverage criteria including the three-day qualifying hospital inpatient stay requirement and observation status pitfalls, PDPM five-component case-mix classification replacing RUG-IV therapy-minutes model, MDS assessm...
Value-Based Care Billing Guide: ACOs, Bundled Payments, MIPS, and Alternative Payment Models
ACO Medicare Shared Savings Program mechanics including risk-adjusted benchmarking and attribution, BPCI-A bundled payment episode cost management and target price risk adjustment, MIPS four-category performance scoring and payment adjus...
Medical Billing Software Guide: EHR vs. PMS, Standalone Billing Software, and RCM Platform Selection
EHR vs. PMS functional distinctions and overlap at charge capture, integrated suite vs. best-of-breed standalone approach trade-offs, key features to evaluate including eligibility verification, claim scrubbing, ERA auto-posting, denial...
Dental Billing Guide: CDT Codes, Medical Necessity Cross-Billing, and Insurance Coordination
CDT code structure by category (diagnostic D0, preventive D1, restorative D2, endodontics D3, periodontics D4, oral surgery D7, orthodontics D8), ADA claim form requirements and dental clearinghouse ecosystem, dental insurance benefit ti...