Resources

Guides to the parts of billing that actually cost money

Written for practice owners and administrators, with every industry figure traced to its source.

Top reasons medical claims get denied

Registration and eligibility errors cause more denials than coding does. Here is what the data actually shows, and what to fix first.

Updated August 20, 2026 · 8 min read

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The largest cause of claim denials is not coding — it is registration and eligibility errors, which account for 24.3% of all denials according to Optum's analysis of 124 million hospital claims. Missing or invalid claim data follows at 15.9%, and authorization issues at 12.8%. Together, front-end problems generate 44% of all denials.

Payers

LCDs and NCDs: how Medicare actually decides what is covered

Coverage is not one rule. A national determination binds everyone; a local one binds only its jurisdiction — and most medical necessity denials trace to the second kind.

August 28, 2026 · 8 min read

Payers

Medicare Part B billing: your MAC decides more than the fee schedule

Medicare is national, but the contractor that adjudicates your claims is regional — and that contractor sets coverage policy, review targets and the answer you get on appeal.

August 28, 2026 · 8 min read

Payers

Medicaid billing: why the same claim behaves differently in every state

Medicaid is fifty programs, not one payer. What that changes about eligibility, filing deadlines, authorization and who actually adjudicates your claim.

August 28, 2026 · 8 min read

Specialty Billing

Nephrology billing: monthly capitation for dialysis and what sits outside it

Dialysis management is paid monthly rather than per visit, and the code depends on the patient's age and how many times they were seen. Almost everything else nephrology does is billed normally.

August 25, 2026 · 8 min read

Specialty Billing

Chiropractic billing: active treatment, the AT modifier and maintenance care

Medicare covers exactly one chiropractic service, and only while the patient is improving. Everything else in the practice is the patient's own cost — which makes the conversation as important as the coding.

August 25, 2026 · 8 min read

Specialty Billing

Wound care billing: debridement by depth and area, and the measurements that prove it

Debridement codes are selected by the deepest tissue removed and the surface area treated. Both are numbers, and a note without them selects the lowest-paying code by default.

August 25, 2026 · 8 min read

Specialty Billing

DME billing: written orders, medical necessity files and the KX modifier

Durable medical equipment is denied on paperwork more than on eligibility. The equipment is usually appropriate; the file supporting it usually is not complete before delivery.

August 25, 2026 · 8 min read

Specialty Billing

Pediatric billing: vaccine administration units and same-day sick visits

Pediatrics bills low-value encounters at high volume, which means a small per-visit error compounds faster here than anywhere else in medicine.

August 25, 2026 · 8 min read

Specialty Billing

Internal medicine billing: wellness visits, chronic care and E/M selection

Medicare does not cover an annual physical. It covers something adjacent with a different name, different content and different codes — and the confusion between them is expensive.

August 25, 2026 · 9 min read

Specialty Billing

Neurology billing: nerve conduction study counts, EEG and botulinum policy

Neurology's diagnostic testing is billed by counting studies, and payers audit those counts more closely than almost anything else in outpatient medicine.

August 25, 2026 · 9 min read

Specialty Billing

Ophthalmology billing: eye codes versus E/M and medical versus vision plans

Eye care is the only specialty with a parallel code set to evaluation and management, and a parallel insurance system to route claims through. Both choices are made per visit.

August 25, 2026 · 9 min read

Specialty Billing

Podiatry billing: the routine foot care exclusion and Q modifiers

Medicare excludes routine foot care by statute, then covers it anyway when specific systemic findings are documented. Nearly all podiatry revenue turns on that exception.

August 24, 2026 · 9 min read

Specialty Billing

OB-GYN billing: the global obstetric package and what falls outside it

One code covers nine months of care. Knowing precisely what it does not cover is where obstetric practices find the revenue they are already earning.

August 24, 2026 · 9 min read

Specialty Billing

Urology billing: cystoscopy bundling, urodynamics components and PSA coverage

Urology runs a diagnostic procedure that is included in almost every therapeutic one, and a test suite billed in components that must each be separately documented.

August 24, 2026 · 9 min read

Specialty Billing

ENT billing: endoscopy bundling, audiology coverage and allergy dose units

An otolaryngology practice runs four different billing models under one roof. Most ENT revenue loss happens at the seams between them.

August 24, 2026 · 9 min read

Specialty Billing

Gastroenterology billing: screening versus diagnostic colonoscopy

One distinction drives most gastroenterology denials and nearly every patient billing complaint: whether the colonoscopy was screening or diagnostic, and what happens when it starts as one and becomes the other.

August 23, 2026 · 9 min read

Specialty Billing

Radiology billing: component splits, orders and medical necessity denials

Radiology is the specialty where you bill for a patient you never met, using an order someone else wrote. That structure produces a denial profile unlike any other specialty.

August 23, 2026 · 9 min read

Specialty Billing

Dermatology billing: lesion measurement, pathology timing and cosmetic denials

Dermatology codes are selected on a measurement taken before the excision and a pathology result that arrives after it. That sequence causes most of the specialty's revenue loss.

August 23, 2026 · 9 min read

Specialty Billing

Pain management billing: frequency limits, imaging guidance and diagnostic blocks

Interventional pain is governed by payer medical policy more tightly than almost any specialty — and the policy is published, which makes most denials predictable.

August 23, 2026 · 8 min read

Specialty Billing

Oncology billing: drug units, wastage and the infusion hierarchy

A unit miscalculation on a biologic can exceed the value of an entire clinic day, in either direction — and it rarely shows up as a denial.

August 23, 2026 · 8 min read

Specialty Billing

Anesthesia billing: base units, time units and medical direction

Anesthesia is the only specialty where payment is calculated rather than looked up — and every input to that calculation is a place revenue leaks.

August 22, 2026 · 8 min read

Specialty Billing

General surgery billing: assistants, co-surgeons and converted procedures

When more than one surgeon is involved, or the procedure changes mid-case, the modifier decides whether the work gets paid at all.

August 22, 2026 · 8 min read

Specialty Billing

Urgent care billing: S-codes, modifier 25 and the walk-in eligibility problem

No scheduled appointment means no window to verify coverage — which puts urgent care at the sharp end of the largest denial category in healthcare.

August 22, 2026 · 8 min read

Specialty Billing

Cardiology billing: component splits, global periods and monitoring intervals

Three denial patterns account for most cardiology write-offs, and all three come from billing correct work under the wrong structure.

August 21, 2026 · 8 min read

Specialty Billing

Family medicine billing: E/M levels, wellness visits and care management

Primary care loses more revenue to undercoding than to denials, and the biggest single confusion is between a Medicare wellness visit and a physical.

August 21, 2026 · 8 min read

Specialty Billing

Why behavioral health claims deny, and what fixes them

Time-based session codes, carved-out payers and visit limits make behavioral health the specialty where correct clinical work most often bills incorrectly.

August 20, 2026 · 8 min read

Specialty Billing

Surgical global periods and why orthopedic claims deny

Global periods, modifier selection and NCCI bundling make orthopedics the specialty where correct surgery is most often billed incorrectly — usually downward.

August 20, 2026 · 8 min read

Specialty Billing

The 8-minute rule and physical therapy billing units

Timed codes, untimed codes and the unit arithmetic between them. Where therapy practices lose revenue that was clinically earned and correctly delivered.

August 20, 2026 · 8 min read

Practice Economics

How much does medical billing cost?

Outsourced billing runs 4–8% of collections. In-house looks cheaper until you cost the whole function rather than one salary. Here is the comparison with the parts most calculations leave out.

August 20, 2026 · 8 min read

Prior Authorization

Prior authorization denials: why 88% go unappealed

Four out of five appealed Medicare Advantage prior-auth denials are overturned. Almost nobody appeals them. The gap is capacity, not merit — and it is measurable.

August 20, 2026 · 8 min read

Best Practices

How to improve your clean claim rate

First-pass acceptance is the cheapest revenue improvement available. Here is what moves it, in order of impact.

August 20, 2026 · 8 min read

Education

What is revenue cycle management?

A plain explanation of RCM, how it differs from medical billing, and which metrics actually indicate whether yours is working.

August 20, 2026 · 8 min read

Credentialing

Credentialing mistakes that delay payments

A provider who cannot bill still costs you a salary. The five credentialing errors that create the longest revenue gaps.

August 20, 2026 · 7 min read

AR Management

How practices lose revenue through AR aging

Accounts receivable decay with age. Past the filing deadline they collect at zero. Here is how to work AR by recoverability.

August 20, 2026 · 7 min read

Verification

Eligibility verification best practices

The cheapest denial prevention available, and the one most practices perform once instead of continuously.

August 20, 2026 · 7 min read

Coding

Understanding annual medical coding updates

ICD-10 changes October 1, CPT changes January 1. Claims are validated against the service date, not the submission date.

August 20, 2026 · 7 min read

Find out what your denials are costing you

A free billing audit reviews your denial rate, AR aging and clean claim rate against industry benchmarks. Takes about two minutes to request. No sales pitch.

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