How Do I Handle Out-of-Network Billing Situations?

November 11, 2025 / admin /

Out-of-network (OON) billing occurs when you provide services to a patient whose insurance plan you don’t have a contract with. While these situations can be more complex than in-network billing, they can also be more profitable if handled correctly. Key Steps for Out-of-Network Billing: 1. Verify Benefits and Set Expectations Before providing services, verify the […]

What is a Modifier in Medical Billing and When Should I Use One?

November 1, 2025 / admin /

A modifier is a two-digit code added to a CPT or HCPCS code to provide additional information about the service performed without changing the basic definition of the procedure. Modifiers indicate circumstances such as bilateral procedures, multiple procedures during the same session, professional versus technical components, services performed by different providers, unusual circumstances, or distinct […]

What is Medical Necessity and Why Do Claims Get Denied for Lack of It?

November 1, 2025 / admin /

Medical necessity means that a service or procedure is appropriate, necessary, and meets accepted standards of medical practice for diagnosing or treating a patient’s condition. Insurance companies deny claims for “lack of medical necessity” when documentation doesn’t sufficiently demonstrate why the service was needed. This is one of the most common denial reasons. To avoid […]

How Long Do Insurance Companies Have to Pay Claims?

November 1, 2025 / admin /

Payment timelines vary by state regulations and payer type. Most states have “prompt payment” laws requiring insurance companies to pay clean claims within 30-45 days of receipt. Medicare typically pays claims within 14-30 days. Some states impose penalties or interest on payers who consistently delay payments beyond statutory timeframes. However, these timelines apply only to […]

What Clean Claim Rate Should My Practice Aim For?

November 1, 2025 / admin /

A clean claim rate of 95% or higher is considered excellent in the medical billing industry. Clean claims are those submitted correctly the first time without errors, requiring no additional information or corrections before processing. The industry average is typically between 75-85%, meaning there’s significant room for improvement in many practices. Low clean claim rates […]

Do You Support Healthcare Providers that Perform Telehealth / Telemedicine?

November 7, 2020 / admin /

Yes, we support medical providers who perform telehealth / telemedicine services. Virtual visits are an excellent way to boost your offices productivity and maintain your patient count. We can work with your established telehealth billing platform or help you set up a new one.

What is Medical Billing?

September 25, 2017 / admin /

Medical billing is the process in which medical providers are paid for performing procedures. The procedures are coded using the most current CPT and ICD-10 codes. The codes are then sent to the insurance companies on the proper HCFA 1500 forms for review and payment. It is the responsibility of the medical biller and coder […]

What’s the Difference Between Medical Billing and Credentialing?

July 25, 2017 / admin /

Medical billing and credentialing for medical providers are two different categories in the healthcare world. Before any medical billing can even be completed, the healthcare provider needs to be credentialed with insurance companies in order to be an approved provider of services. Becoming credentialed as an in-network provider dictates the set amount of reimbursement that […]

What are Our Rates?

July 25, 2017 / admin /

Medwave and its team of medical billing and credentialing specialists understand the time and effort it takes to run an efficient medical office. That is why every office receives specialized attention and a tailored plan to help your practice succeed. Every contract is priced according to the needs of your practice and is always based upon […]

What Types of Medical Practices do We Serve?

July 25, 2017 / admin /

Although not limited to (as we have done practices outside of these), we typically serve the following medical practices: Behavioral Health, Durable Medical Equipment (DME), Toxicology Labs, Speech Therapy, Genetic Testing Labs, Substance Abuse, Chiropractic, Occupational Therapy, Family Practice, Internal Medicine, Physical Therapy, Holistic Therapy, Sleep Study Labs, Transportation, Medical Cannabis

Do You Support Genetic Testing Labs with their Billing Needs?

January 30, 2017 / admin /

Yes, we provide genetic testing lab billing services. Our team is experienced and well educated in the medical billing and coding guidelines of genetic testing lab specialists and has firsthand experience working with commercial and government companies to get your claims paid fast and efficiently.

Do You Fix Denied Medical Claims?

January 20, 2017 / admin /

Yes, once you contractually sign with us and we start your medical billing, we will analyze past claims as well. Those denied medical claims can be fixed and you will be paid out on them.

Which Regions do We Serve?

January 12, 2017 / admin /

Although we serve the entire United States and Europe (as billing codes do not often differ), we target the Greater Pittsburgh Region. Generally speaking, this includes twenty-eight Pennsylvania counties, nineteen West Virginia counties, five Ohio counties, and two Maryland counties. Outside of the Pittsburgh region, we service Cleveland, Ohio medical billing and credentialing, Philadelphia, PA […]

Do You Partner with 3rd Party Medical Groups?

July 24, 2016 / admin /

Medwave does partner with a number of 3rd party groups, especially medical product sales groups that have medical provider clients in need of credentialing and billing.