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Billing questions, answered plainly.

30 guides on denials, underpayments, the No Surprises Act and AI in RCM.

AI in RCM

AI in Revenue Cycle Management: Where It Helps and Where It Doesn't

A practical guide for procedural practices on how AI is used across the revenue cycle, what it does well, where it fails, and the safeguards to require.

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AI in RCM

AI Denial Prediction: Stopping Denials Before the Payer Sees the Claim

How denial prediction models score claims before submission, what data they use, and how procedural practices should act on the score.

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AI in RCM

AI Coding Cross-Checks for Procedural Operative Notes

How AI compares operative notes with billed CPT codes and modifiers to catch missed add-ons and unsupported lines, and why a credentialed coder must still decide.

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AI in RCM

AI-Drafted Appeal Letters: Faster Appeals That Still Win

How AI drafts denial appeals using the medical record and payer policy, what a strong appeal contains, and the human review that keeps it accurate.

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AI in RCM

AI in Prior Authorization for Procedures

How AI checks authorization requirements, assembles clinical documentation and tracks status for pain, spine and orthopedic procedures, and where people still matter.

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AI in RCM

AI Eligibility Verification and Coverage Discovery

How automated eligibility checks and coverage discovery prevent front-end denials, and what they miss.

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AI in RCM

AI Underpayment Detection: Finding Claims Paid Below Contract

How automated contract comparison finds underpayments hidden in contractual adjustments, with examples from pain, spine and anesthesia billing.

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AI in RCM

AI AR Prioritization: Working the Claims Most Likely to Pay

How AI ranks aged accounts receivable by likely recovery, balance and deadline so follow-up teams work the right claims first.

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AI in RCM

AI Payer Policy Tracking: Catching Rule Changes Before They Deny Claims

How AI monitors payer bulletins, medical policies and Medicare LCD updates that affect procedural codes, and turns them into claim edits.

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AI in RCM

Using AI for No Surprises Act Disputes and IDR

How AI helps out-of-network physicians track No Surprises Act deadlines, identify eligible claims and assemble IDR evidence, with human control of every filing.

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AI in RCM

AI Charge Capture: Finding Services That Never Reached a Claim

How AI compares schedules, procedure logs and documentation with charges to find missed services, without encouraging over-coding.

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AI in RCM

AI, HIPAA and Human Review: The Safeguards to Require

What procedural practices should require from any billing partner or vendor using AI on patient data: BAAs, minimum necessary access, no model training on PHI, audit logs and human review.

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Underpayments & AR

What Is an Underpayment in Medical Billing?

How to recognize claims paid below your contracted rate, where underpayments hide in pain, spine and anesthesia billing, and a simple test to find them.

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Underpayments & AR

Bilateral Procedures and Modifier 50: The Quiet Underpayment

How bilateral procedures should be billed and paid, why modifier 50 lines are often short-paid, and how pain practices can check their remittances.

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Denials & coding

The 77003 Trap: When Fluoroscopic Guidance Is Billable

Why CPT 77003 is usually not reported with epidural and facet injections, where separate imaging can still apply, and how pain practices avoid denials and audit risk.

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Denials & coding

Modifier 59 Is Not a Magic Word: Distinct Procedures in Pain Management

When modifier 59 and the X{EPSU} modifiers are supported in pain management, why payers scrutinize them, and how to document distinct services.

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Underpayments & AR

Your AR Has an Expiry Date: Timely Filing and Appeal Deadlines

How timely filing limits and appeal windows work, why 60+ day AR turns into write-offs, and how to protect claims before deadlines pass.

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Underpayments & AR

Recovering 60+ Day AR Before It Turns Into Write-Offs

A practical approach to working aged accounts receivable: sorting by deadline, finding the real blocker and resolving claims before timely filing expires.

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Denials & coding

CO-45 Isn't Always the End of the Story

What CARC CO-45 means, when the adjustment is correct, and when it hides an underpayment.

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Denials & coding

Anesthesia Time Is Money: How Anesthesia Time Units Are Calculated

How anesthesia claims are paid using base units, time units and conversion factors, how medical direction modifiers change payment, and where groups lose revenue.

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Denials & coding

22842 Deserves to Be Paid: Spinal Instrumentation Denials

Why posterior segmental instrumentation codes are denied with spinal fusion, what the operative report must show, and how to appeal.

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Denials & coding

The Modifier 25 Tug-of-War in Orthopedics

When modifier 25 is allowed on the same day as a procedure, how it differs from modifier 57, and how orthopedic groups protect same-day E/M payments.

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Denials & coding

EMG/NCS: Documented or Denied

Why electromyography and nerve conduction studies are denied, how the 959xx codes work together, and what reports must show.

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Denials & coding

Where ASC Claims Go Quiet: Carve-Outs and Physician Billing

How ambulatory surgery center carve-outs, facility vs professional claims and the No Surprises Act affect physicians operating at ASCs.

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No Surprises Act

The QPA Is an Opening Offer: What the Qualifying Payment Amount Means

How health plans calculate the qualifying payment amount under the No Surprises Act, why it is often low for physicians, and how it is used in IDR.

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No Surprises Act

30 Business Days: The No Surprises Act Open Negotiation and IDR Timeline

A step-by-step timeline of No Surprises Act payment disputes, from initial payment to open negotiation, IDR initiation, offers, decision and payment.

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No Surprises Act

IDR Isn't Only for Hospitals: Federal IDR for Independent Physicians

Which independent physicians can use federal independent dispute resolution under the No Surprises Act, which claims qualify, and what evidence makes a strong offer.

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No Surprises Act

Anesthesia and the No Surprises Act

Why anesthesia groups are among the specialties most affected by the No Surprises Act, how payments are disputed, and what groups should track.

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Choosing a partner

We Only Win When You Get Paid: How Contingency Medical Billing Works

How contingency-based medical billing pricing works, what 'net collections' means, and the questions to ask before signing.

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Choosing a partner

How to Choose a Medical Billing Company for a Procedural Practice

The questions procedural practices should ask before choosing an RCM partner: specialty experience, coding credentials, reporting, pricing, HIPAA and how AI is used.

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