Medical Billers and Coders

Practices can close AR gaps in maternity billing by strengthening documentation, improving global package accuracy, managing denials proactively, and tightening revenue cycle workflows. Maternity billing is complex due to bundled payments, long global periods, and payer-specific rules. When processes are inconsistent, accounts receivable (AR) grow, cash flow slows, and revenue leakage increases. Understanding where AR gaps originate is the first step toward fixing them. Why Do AR Gaps Occur in Maternity Billing? Maternity billing AR gaps often result from errors in managing the global maternity bundle. Common causes include: Incorrect global package billing Missed charges outside the bundle Delayed claim submission Authorization errors Incomplete documentation Because maternity care spans months, small billing mistakes compound over time. How Does the Global Maternity Package Affect Accounts Receivable? The global maternity package includes prenatal visits, deliver...

Medical necessity audits are increasing in the ASC era because payers are closely scrutinizing outpatient surgical procedures to control costs and prevent improper reimbursement. As more procedures shift to Ambulatory Surgery Centers (ASCs) , payers are tightening documentation standards and reviewing claims more aggressively. This shift directly impacts ASC billing , reimbursement timelines, and compliance risk. Understanding this trend is essential for protecting surgical revenue. What Is Driving the Rise in Medical Necessity Audits? The expansion of outpatient surgery has increased payer oversight. Procedures once performed in hospitals are now commonly done in ASCs, often at lower cost. Payers are responding with: Increased medical necessity audits Stricter pre-authorization requirements Targeted review of high-cost procedures Greater documentation scrutiny The goal is cost control, but the result is higher denial risk. How Do Medical Necessity Audits Impact ASC Revenu...

CPT 90482–90484 improves preventive care reimbursement by allowing providers to accurately bill for vaccine administration with counseling, ensuring proper payment for time, complexity, and patient interaction. These codes help internal medicine and primary care practices capture revenue that is often lost due to undercoding or improper vaccine billing. When used correctly, CPT 90482–90484 strengthens preventive service reimbursement and reduces billing gaps. What Are CPT 90482–90484? CPT 90482–90484 are vaccine administration codes used for reporting immunization services, particularly when counseling is provided. These codes: Reflect the physician's or qualified healthcare professional's involvement Account for counseling during vaccine administration Support preventive care billing accuracy Accurate use of these codes ensures compliance with preventive care reimbursement guidelines . Why Do Vaccine Administration Codes Impact Revenue? Improper vaccine...

The 16-day RPM rule is becoming less of a revenue barrier for OBGYNs due to regulatory clarifications, improved device compliance, and better billing workflows. Previously, the requirement that remote patient monitoring (RPM) devices collect data for at least 16 days per 30-day period limited reimbursement opportunities. For OBGYN practices managing pregnancy-related monitoring and chronic maternal conditions, this rule often restricted consistent RPM reimbursement . Recent operational adjustments and clearer CMS guidance are changing how practices approach RPM billing for OBGYNs . What Is the 16-Day RPM Rule? The 16-day RPM rule requires that patient monitoring devices record and transmit data for at least 16 days within 30 days to qualify for monthly RPM reimbursement. This rule was designed to ensure consistent patient engagement, but it created challenges in: Short-term pregnancy monitoring Intermittent blood pressure tracking Gestational diabetes management Post...

Strict collection policies influence ASC valuation by directly improving cash flow, reducing bad debt, strengthening EBITDA, and increasing overall financial predictability. For Ambulatory Surgery Centers (ASCs), valuation is heavily tied to revenue integrity, accounts receivable performance, and clean financial reporting. Weak collection processes create revenue leakage, while structured and disciplined policies increase buyer confidence and enterprise value. In private equity and acquisition environments, predictable collections equal higher multiples. Why Do Collection Policies Matter in ASC Financial Performance? ASC valuation is closely tied to revenue cycle strength. When collection policies are inconsistent, centers experience: High patient balances Extended accounts receivable cycles Increased write-offs Reduced operating margins Strict ASC collection policies ensure timely payment collection, improve liquidity, and stabilize revenue streams. How Do Stri...

Prior authorizations in dermatology are becoming more complex, more restrictive, and more time-consuming, leading to increased claim delays and revenue disruption. As biologics, specialty drugs, and advanced dermatologic procedures become more common, payers are tightening approval requirements. This shift is directly affecting dermatology billing , reimbursement timelines, and administrative workload. Understanding the current landscape is critical for protecting practice revenue. Why Are Prior Authorizations Increasing in Dermatology? The rise in prior authorizations in dermatology is largely driven by high-cost biologics and specialty treatments. Key factors include: Expensive biologic therapies Step therapy requirements Formulary restrictions Increased payer cost control strategies Because dermatology treatments often involve long-term therapy, payers apply strict review standards before approving coverage. How Are Prior Authorizations Impacting Dermatology ...