Medical Billers and Coders

  For a multi-surgeon general surgery group, global period documentation can look like a small operational issue. A missing postoperative note, unclear transfer of care, incomplete procedure detail, or poorly supported modifier may not seem significant on a single claim. Across dozens or hundreds of surgical cases, however, those gaps can create a much larger revenue-cycle problem. The issue is not simply whether a claim gets denied. Poor global-period documentation can make it harder to determine what work was actually performed, which surgeon was responsible for that work, whether a service was included in the surgical package, and whether a separately reported service was properly supported. Medicare generally includes postoperative services within the payment for procedures assigned a 10-day or 90-day global period. For major surgery, the 90-day global period includes the day of surgery and the 90 days following it, along with the applicable preoperative period. For a multi-sur...

  A practice can be busy, profitable on paper, and still struggle to pay its bills on time. That is when a credit line starts looking like a solution. The practice uses borrowed money to cover payroll, vendors, technology, rent, or other operating expenses while waiting for insurance payments to arrive. The problem is that repeated dependence on a credit line can indicate something deeper: the practice is not converting earned revenue into cash quickly enough. The problem may not be a lack of revenue. It may be a broken accounts receivable (A/R) engine. When Revenue Exists but Cash Does Not A medical practice can generate significant charges every month without collecting that money efficiently. Claims can remain in A/R because of coding issues, payer delays, eligibility problems, authorization issues, claim rejections, denials, underpayments, or weak follow-up. The result is a growing gap between services provided and cash received. When that gap becomes large enough, leadership m...

Ambulatory surgery centers (ASCs) are facing increasing pressure to keep professional and facility claims consistent. A surgeon may submit a professional claim for a procedure while the ASC submits a separate facility claim for the same encounter. Although these claims serve different billing purposes, the clinical details behind them should tell the same story. When surgeon coding and facility claims do not match, payers may see inconsistencies that can trigger claim reviews, payment delays, downcoding, or denials. The problem is not always an incorrect CPT code. Sometimes the issue is that two correctly prepared claims do not appear synchronized. The ASC Synchronization Problem ASC billing involves multiple parties. The surgeon or physician group submits the professional claim, while the facility submits the institutional claim for the services and resources provided by the ASC. Both claims can contain different codes because they represent different components of the same encounter....

Medicare Advantage EEG billing can become challenging when a claim is not denied outright but is instead reimbursed at a lower level than the neurologist expected. This is known as downcoding , and it can create a hidden revenue problem for neurology practices. The physician may have performed the appropriate EEG service and documented the patient's clinical condition, yet the final payment may not reflect the level of service originally submitted. Because the claim can still appear as "paid," this type of reimbursement loss may be overlooked during routine billing reviews. For neurologists, understanding how EEG downcoding works is important for protecting legitimate reimbursement and identifying recurring payer patterns. What Is Medicare Advantage EEG Downcoding? EEG downcoding occurs when the submitted service is adjudicated or reimbursed at a lower level than the service originally reported. The important distinction is that downcoding is different from a traditional ...

Choosing a medical billing or RCM vendor for a Florida dermatology practice requires more than comparing collection percentages and monthly fees. Dermatology billing has specialty-specific risks, particularly when a practice performs Mohs micrographic surgery, pathology-related services, biopsies, and other procedures where documentation, medical necessity, coding, and payer policies directly affect reimbursement. One important area to examine is the vendor's ability to prevent and defend CO-50 denials . CARC 50 indicates that a service was considered non-covered because the payer did not determine it to be medically necessary. CMS guidance also shows that CO-50 can be used following medical review when a payer determines that coverage requirements have not been met. For a Florida dermatology practice, the vendor evaluation process should therefore go beyond asking, "How much do you collect?" The better question is: "How do you protect our revenue when a payer challe...

For family practices, 2026 is not simply another year of Medicare payment updates. Changes to physician reimbursement are creating different financial effects depending on where and how care is delivered. That raises an important question for practice owners and administrators: Is your family practice reimbursement model positioned to benefit from CY2026 payment changes, or is it absorbing the downside? The answer depends on more than the headline Medicare conversion factor. Practice location, service mix, site of service, payer mix, coding, and revenue-cycle performance can all influence the actual financial outcome. Understanding these differences can help family practices make better decisions about staffing, service delivery, coding, and billing operations. The CY2026 Payment Environment Is Not Uniform A common mistake is to look at a Medicare payment update and assume every family practice will experience the same financial impact. That is rarely the case. Two family practices can...