Medical Billers and Coders

  The Part No One Warns You About Your OB-GYN claims are getting paid. Your revenue looks stable. Your billing team says things are “fine.” That doesn’t mean your practice is safe. Most OB-GYN audits don’t start with denials, warnings, or red flags you can see. They start silently , months after payers have already paid your claims—when the money has been spent, the charts are archived, and staff turnover has already happened. By the time the recoupment letter arrives, the damage is already done. The Reality Most Practices Learn Too Late Payers don’t audit claims they deny. They audit claims they’ve already paid . For OB-GYN practices, audits typically occur 6 to 18 months after payment . That timing is intentional. It gives payers leverage—because now you’re being asked to return money that’s already been allocated to payroll, rent, malpractice premiums, and growth. This isn’t a reflection of bad intent or sloppy practices. It’s how the system is designed. And OB-GYN...

  The Silent Revenue Leak in OB-GYN Practices Most OB-GYN practices don’t realize they’re bleeding money. Not in dramatic, headline-grabbing ways, but quietly, steadily, month after month. The phones are ringing, appointment slots are full, deliveries are happening, and yet the numbers never seem to match the effort. Sound familiar? This is often the first sign of hidden OB-GYN billing errors working behind the scenes. These errors don’t announce themselves. They don’t crash your systems or send angry alerts. Instead, they slip through claims, hide in coding nuances, and quietly shave thousands—or millions—off your annual revenue. OB-GYN billing is uniquely complex compared to other specialties. Between global maternity packages, split billing scenarios, high-risk pregnancy coding, and ever-changing payer rules, the margin for error is enormous. A single missed modifier or incorrectly bundled service might seem insignificant on its own. But when repeated across hundreds or thousand...

Ambulatory Surgical Centers don’t lose Medicare revenue because of low case volume. They lose it because of one recurring, preventable failure: Incorrect coding and documentation for Medicare’s ASC-specific payment rules. This single issue triggers denials, underpayments, delayed reimbursement, and permanent write-offs — especially at year-end. If your ASC’s Medicare revenue feels unpredictable, this is why. The #1 Revenue Killer: Not Billing Medicare the “ASC Way” Medicare does not treat ASCs like hospitals or physician offices. Yet many ASCs still: Use hospital-style assumptions Miss ASC-only payment rules Underestimate Medicare’s bundling logic The result? Claims get paid less than expected — or not at all. Where Medicare ASC Claims Go Wrong 1. Incorrect CPT eligibility for ASC payment Not every CPT code is payable in an ASC setting under Medicare. Common mistakes: Billing procedures not on Medicare’s ASC approved list Assuming “covered in hospital” = “covered in ASC” Missing annual...

Every medical practice talks about growth. Few talk honestly about what’s killing their revenue. It’s not patient volume. It’s not payer mix. It’s the silent trio draining cash every month : denials, payment delays, and write-offs . By the time most practices notice the damage, the money is already gone. The Hidden Revenue Crisis in Healthcare Practices Across the U.S., practices lose 5–10% of collectible revenue every year due to preventable billing failures. That loss doesn’t show up as a single error — it spreads quietly across: Denied claims that never get appealed Delayed payments that age past recovery Write-offs accepted as “normal operations.” Individually, they look manageable. Collectively, they destroy profitability. Denials: Where Revenue First Breaks Claim denials are not random. They’re predictable—and preventable. Common denial drivers: Incorrect CPT–ICD pairing Missing or expired prior authorizations Medical necessity documentation g...

Year-end is when neurology practices quietly lose serious money. Not because of low patient volume—but because complex neurology services collide with: Strict payer policies Prior authorization backlogs Documentation-heavy encounters Staff fatigue and holiday delays If your neurology revenue dips every December, your billing workflows are almost certainly the problem. Why Neurology Billing Breaks Down at Year-End Neurology billing is already complex. Year-end multiplies the risk. 1. Long treatment cycles crossing calendar years EEGs, EMGs, sleep studies, infusion therapy, and chronic neuro management often span months. Claims get: Filed late Split incorrectly Denied for “episode of care” confusion 2. Prior authorization delays High-cost neuro services face tighter year-end review: Imaging Botox for migraine Nerve conduction studies Infusions Missing or expired auths = automatic denials. 3. Medical necessity denials spike Payers demand strong clinical justification for neuro procedures....

Well-woman exams sound simple. They’re not. Gynecology practices lose thousands every year because payers deny, downcode, or bundle these visits due to coding errors, missing documentation, or confusion between preventive vs. problem-oriented care . If your practice is seeing unpaid or underpaid Well Woman claims, here’s the reality: It’s not the payer. It’s not the patient. It’s your coding workflows—and they’re costing you real money. Below is the no-nonsense breakdown of how to stop revenue leakage immediately. Why Gynecology Practices Keep Losing Money on Well-Woman Exams Most losses happen because of wrong CPT/ICD pairing , incorrect use of preventive codes, and failure to separate problem visits from preventive services. Top revenue killers: 1. Using the wrong preventive CPT code Common mistakes include: Billing 99381–99397  is incorrectly based on age Missing counseling or preventive components that justify higher-level codes Treating a preventive exam...

Top Year-End Billing Pain Points Dermatology practices face some of the most complicated coding and reimbursement issues at the end of the year. Seasonal appointment spikes put additional pressure on billing teams struggling with: Declining reimbursements for common procedures such as biopsies, lesion excisions, cryotherapy, and Mohs services Payer-to-payer coding variability, especially on pathology-linked services Bundling disputes where multiple procedures performed in the same session are denied due to improper modifier usage Cosmetic vs. medical necessity confusion, leading to denials when documentation doesn’t clearly justify why a lesion needed removal Increased scrutiny on skin cancer—related services due to rising utilization These persistent challenges often leave dermatologists with more unpaid claims, lost revenue, and rising patient AR at year-end. What Practices Are Doing Right Now To reduce claim rejections before the year ends, most dermatology practices are: Re-trainin...

  As the year ends, most professionals across industries prepare for holidays and downtime. But in the U.S. healthcare market, December is the most stressful and high-risk month for revenue. Physicians are racing against: Timely filing limits Insurance backlog Year-end payer rule changes Sudden increase in patient visits Documentation delays from overworked staff The result? Revenue losses peak right when practices expect maximum collections . What’s Currently Trending in the U.S. Healthcare Year-End Market These issues are dominating year-end 2025: Patient deductibles reset on January 1st, so patients rush for care now Payer audits are up, especially for medical necessity Electronic authorization errors are delaying high-value claims Denials returning too late for appeal before the December cutoff Short staffing and seasonal absences are slowing billing workflows Practices are urgently trying to: Submit every pending claim before cut-...

  Why Texas Skilled Nursing Facilities Need RCM Support at Year-End As the year ends, Skilled Nursing Facilities (SNFs) across Texas face high operational pressure—increased patient volumes, PDPM billing complexities, and Medicaid authorization challenges. More than 76% of Texas SNFs experience cash flow delays due to claim denials and backlog in Aging AR . Meanwhile, insurers and government payers tighten audits and documentation checks, increasing payment risk for the facilities. This is where partnering with an experienced medical billing company  becomes crucial. Texas SNF Billing Challenges Right Now Texas SNFs are dealing with: • Medicaid Managed Care claim confusion and authorization errors • Delays in reimbursement due to PDPM documentation gaps • Labor shortages affecting billing and follow-ups • Increased scrutiny from Texas Health & Human Services (HHSC) on compliance • High volume of 60–120+ days Aging AR stuck in payer queues These problems lead...

Year-end is one of the most stressful periods for OBGYN physicians in Arizona. With rising patient volume, high-risk maternity cases, changing payer rules, and tight claim-filing deadlines, revenue can easily slip through the cracks. To maintain cash flow and comply with reimbursement requirements, many Arizona OBGYN clinics near me now rely on local medical billing services to ensure accuracy, speed, and maximum reimbursement before December closes. Partnering with a medical billing company helps OBGYN providers avoid denials, reduce administrative burden, and ensure every claim gets paid the first time. Why Year-End is Critical for Arizona OBGYN Practices High patient load due to prenatal & delivery scheduling before deductibles reset Increased documentation requirements for postpartum care Finalizing annual reporting for OB episodes and global maternity billing Outstanding claims must be rechecked to prevent lost revenue Staff shortage issues increase errors and delays Arizona-S...

  Plastic surgeons in Arizona are facing a demanding year-end period filled with growing patient volume, increased cosmetic procedure interest, and strict payer compliance regulations. From Scottsdale to Phoenix and Tucson, providers often struggle to balance high-quality surgical care with complicated claim requirements—leading to delayed payments, excessive denials, and revenue leakage. Partnering with a dedicated medical billing company can help Arizona plastic surgery practices secure faster reimbursements while staying fully compliant. Why Year-End is Critical for Plastic Surgeons in Arizona High demand for elective and cosmetic procedures before the holidays Last-minute insurance submissions as patients meet deductibles Increased documentation requirements for reconstructive procedures Need to close out old AR before payer cutoff deadlines New 2025 insurance policy revisions impacting approvals State-Specific Challenges: Arizona Plastic Surgery Practices...