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Payers Are Using AI to Reduce E/M Reimbursement. Protect Your Practice Revenue → Save $25 with code DOWN25

Billing

Billing

Medicare Overpays

Patient Refund Rules Are Changing: What Your Practice Needs to Know Now

Accurate patient billing is not optional—you rely on it to protect your revenue, stay compliant, and maintain patient trust. When your billing processes are inconsistent or unclear, you increase the risk of patient overpayments, credit balances, and regulatory exposure. These issues are becoming more important as lawmakers focus on protecting patients from financial harm. You […]
Published Date: May 25, 2026
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Using modifier 25

Modifier 25 Errors That Are Costing Your Practice Thousands

If your practice is billing Evaluation and Management (E/​M) services alongside procedures, Modifier 25 can make or break your reimbursement. When used correctly, it ensures you get paid for the full scope of care you provide. When used incorrectly, it can trigger denials, audits, and lost revenue. Modifier 25 is one of the most scrutinized […]
Published Date: April 28, 2026
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risk adjustment

G0136 Billing Made Simple: Do You Need Positive SDoH Findings to Get Paid?

If you’re only focusing on clinical care, you’re missing a huge part of what drives patient outcomes. Research from the U.S. Department of Health and Human Services shows that clinical care accounts for only about 20% of health outcomes, while Social Determinants of Health (SDoH) can influence up to 50%. That means factors like housing, […]
Published Date: April 21, 2026
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Workplace bullying

Why Your POS Code 22 Billing Is Getting Denied and What to Do

When you submit claims, small details like Place of Service (POS) codes can make or break your reimbursement. POS codes tell payers exactly where care was provided—and they use that information to determine how much you get paid and whether your claim is even valid. If you get it wrong, you risk denials, delays, audits, […]
Published Date: April 16, 2026
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No surprise billing act

Get Paid What You Deserve Using the IDR Process for Medical Billing

If your practice provides out-of-network care, the No Surprises Act has completely changed how you get paid. You can no longer balance bill patients in many situations—meaning your revenue now depends on how effectively you handle payer disputes. That’s where the Independent Dispute Resolution (IDR) process comes in. It gives you a structured way to […]
Published Date: April 15, 2026
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Telehealth Claim Denial

After Insurance Denials: When You Can Bill Patients (and When You Can’t)

When an insurance claim is denied, you don’t just lose reimbursement—you create a compliance and patient experience risk for your practice. If you bill incorrectly, you could trigger patient complaints, audits, or even regulatory scrutiny. According to the Centers for Medicare & Medicaid Services, billing must follow strict payer rules and documentation standards, especially when […]
Published Date: April 7, 2026
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TELEHEALTH_PLACE_OF_SERVICE

Think You’ve Mastered Place of Service Codes? Take This Quick Billing Reality Check

You may think Place of Service (POS) codes are just another box to fill in—but they directly impact your reimbursement, compliance, and audit risk. POS codes are two-digit codes that tell payers exactly where services were provided, and they’re required on every professional claim. If you get them wrong, you risk claim denials, reduced payments, […]
Published Date: April 2, 2026
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Appeal letter

Responding to Payer Audit Letters: Protect Your Revenue and Stay Compliant

Payer audit letters are increasing across healthcare, and in 2026 they’re more data-driven than ever. Medicare contractors, commercial payers, and government integrity units use advanced analytics to flag billing outliers, documentation gaps, and compliance risks. If your practice receives an audit letter, your response can directly impact reimbursement, compliance risk, and future audits. The key […]
Published Date: March 25, 2026
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Place of service codes

Stop Losing Revenue from Incorrect Place of Service Codes

If your practice submits claims to Medicare or commercial payers, selecting the correct Place of Service (POS) code is essential. One small coding error can trigger claim denials, payment reductions, compliance risk, or payer audits. Place of Service codes identify where a patient received care—such as your office, a hospital outpatient department, or the patient’s […]
Published Date: March 17, 2026
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Medicare Advantage Overpayments

Medicare Advantage Out-of-Network Coverage: How Your Medical Practice Can Prevent Claim Denials

If your medical practice treats Medicare Advantage patients, understanding out-of-network coverage rules is essential to avoid claim denials, compliance risks, and lost revenue. Many billing teams assume these plans never cover out-of-network care, but federal Medicare rules require coverage in specific situations. Knowing these requirements protects reimbursement and prevents unnecessary appeals. Federal CMS regulations require […]
Published Date: March 16, 2026
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