ABA Therapy CPT Codes: What Every ABA Provider Needs to Bill Correctly
If you run an ABA practice, you know this pain. You delivered the therapy, the kid made progress, and then the claim gets denied. Most of the time, it is not the therapy. It is the coding. Providers are using the right ABA service but the wrong code, wrong time, or wrong credential. That is […]
When to Outsource Insurance Verification: A Complete Guide for Practices
Look, a claim doesn’t start when you hit submit. It starts two days before. When someone checks the insurance. If that check is off, coverage is actually inactive, the deductible isn’t looked up, or the referral is missing, the visit still happens. You just don’t get paid for it. And then it’s your front desk […]
Prior Authorization in Medical Billing: Why Approved Services Still Face Payment Problems
Prior authorization is an important checkpoint in the healthcare revenue cycle, but getting an approval does not always mean the claim will be paid. A procedure, treatment, diagnostic service and/or medical item may be approved by a payer prior to receipt, and the final claim may be submitted against other billing/coding/documentation/coverage requirements. This poses a […]
Wound Dressing CPT Code Explained
There is no standalone CPT code for a routine wound dressing change. Payers bundle simple dressing changes into the E/M visit or the wound care procedure performed that day. Specific codes apply only when a debridement or compression procedure happens alongside the dressing. Get the code wrong and the claim denies. This guide breaks down […]
Risk Stratification in Healthcare: A Guide for Connecticut Providers
A patient panel of 1,000 rarely spreads its costs evenly. Roughly 20 percent of patients typically drive most of the spending and clinical complexity in a practice. Risk stratification is how practices identify that 20 percent before a crisis happens instead of after. For Connecticut providers, it also shapes how care is documented, coded, and […]
Prospective Payment System: What Providers Must Know
As a healthcare provider, you have probably heard the term “Prospective Payment System” in meetings, on conference calls, or in those dense CMS mailers that land in your inbox. You might even have a vague sense that it has something to do with how Medicare pays hospitals. But unless you have had to fight a […]
Emergency Room Billing Levels Explained | ER E/M Coding Guide
Most emergency departments leave revenue on the table without knowing it. The cause is almost always miscoded billing levels. ER billing levels determine reimbursement for every ED visit. Errors in either direction mean denied claims, payer audits, or uncollected revenue compounding across thousands of encounters. This guide covers what emergency medicine providers and revenue cycle […]
Coordination of Benefits in Healthcare
Coordination of benefits (COB) is the difference between a clean claim that pays the first time and a claim that gets stuck in a denial loop for weeks. It determines who pays first, what the secondary payer can cover, and what the patient truly owes after all adjustments. When a patient has two insurance plans, […]
Step-By-Step Eligibility Verification Process
Nearly half of providers say patient information errors collected at registration or check-in are a primary cause of denied claims. When claims are denied due to eligibility issues, they require rework or resubmission and often result in writing off the balance as uncollectible. That is revenue that left the building because someone skipped a step […]
How to Speed Up Prior Authorization for Medication
Prior authorization delays push treatment back for weeks. Your staff submits the request, then waits. Meanwhile, the patient calls asking why their medication is still not approved. Why Prior Authorization for Medication Takes So Long Most prior authorization delays come from the submission itself, not the payer’s review queue. Incomplete clinical notes, missing diagnosis codes, […]