If you’ve ever asked whether medical billing and revenue cycle management (RCM) are the same thing, you’re not alone. The two terms get used interchangeably all the time, even inside healthcare organizations that should know better. They’re related, but they’re not identical, and the difference matters if you’re trying to figure out where your practice […]
Billing vs RCM, Claim Denials, Coding Compliance, Healthcare Billing, Prior Authorization, RCM
New versus established patient billing goes wrong when a patient’s status is misjudged on the front end, which can risk a denial or quietly underpay every claim for a visit that should have coded higher. The distinction between new and established comes down to a specific three-part test, not a front-desk gut check, and the […]
Billing Challenges, Outsourced Billing, Revenue Cycle Management, Revenue Cycle Optimization, Verifying Insurance
HCC coding decides whether a patient with type 2 diabetes and stage 4 chronic kidney disease looks healthy to a Medicare Advantage plan on January 1. All it takes is a year of visits where the kidney disease was managed but never made it into an assessment and plan. Hierarchical Condition Category (HCC) coding is […]
Chronic Care Management, HCC, HCC Coding, Hierarchical Condition Category, Population Health Management, Value Based Care
As a medical biller or coder, choosing the correct Current Procedural Terminology (CPT) code is crucial for accurate reimbursement. However, with thousands of codes available, it can be overwhelming to find the right one for your services. We offer a free step-by-step guide on how to choose the correct CPT code for your medical billing […]
Billing, Correct CPT Code, CPT Billing Codes, CPT-10, Modifiers
CPT codes for DME billing apply to Durable Medical Equipment (DME), which refers to medical equipment and supplies that are intended for long-term use by individuals with medical conditions or disabilities. Some common types of DME include wheelchairs, walkers, crutches, canes, hospital beds, patient lifts, oxygen equipment, nebulizers, and continuous positive airway pressure (CPAP) machines. […]
DME, DME Billing Service, DME CPT Codes, Medical Billing
The urine drug screen CPT codes most labs and practices bill are 80305, 80306 and 80307, and the right one depends on how the screen is read rather than how many drugs it covers. All three are presumptive codes, which means they identify possible drug use and are billed once per date of service. Older […]
CPT Codes, Toxicology Billing, Toxicology CPT Codes, Toxicology Laboratory Billing
CPT codes for genetic testing billing matter because genetic testing has become an essential tool in medicine, providing valuable insights into a patient’s health and disease risk. As genetic testing becomes more prevalent, medical professionals must handle billing and coding for these tests. Correct coding ensures that the provider is reimbursed for the services provided, […]
Genetic Testing Billing, Genetic Testing CPT Codes, Microarray CPT Codes, Molecular Pathology CPT Codes, Next-generation Sequencing CPT Codes
CPT codes for COVID-19 billing exist because the pandemic has impacted the world significantly, causing widespread illness, death, and economic disruption. The virus, also known as SARS-CoV-2, primarily spreads through respiratory droplets when an infected person talks, coughs, or sneezes. COVID-19 symptoms range from mild to severe and may include fever, cough, fatigue, body aches, […]
Coronavirus, COVID-19 billing, COVID-19 CPT Codes, CPT Codes, SARS-CoV-2
Behavioral health HCPCS codes such as H0004, H0031, H0036 and H2019 are how most state Medicaid programs pay for community mental health and substance use services, while CPT codes such as 90834 and 90837 cover psychotherapy billed to Medicare and commercial plans. Many practices bill both sets in the same week, and the two follow […]
Behavioral Health Billing, Behavioral Health CPT Codes, Medical Billing
At present, medical credentialing is one of the most critical components of healthcare administration. However, it is an endeavor that comes with its own set of challenges. From simplifying the entire process to ensure credentialing committees have adequate resources, there are a lot of challenges that need to be addressed to ensure that things run […]
Credentialing Challenges
Credentialing and contracting are essential components of healthcare operations. Credentialing is the process of verifying the qualifications and professional background of healthcare providers, while contracting involves establishing agreements between healthcare providers and payers to ensure payment for services rendered. These processes are crucial for ensuring that healthcare providers deliver high-quality services and receive fair compensation […]
Contracting Checklist, Contracting Use Case, Credentialing and Contracting, Credentialing Checklist, Credentialing Use Case
What is EDISS Connect? EDISS Connect is a powerful web-based application that allows healthcare providers to manage their claims data more effectively. With its user-friendly interface and advanced features, the EDISS platform simplifies the claims submission process, tracks payment status, and provides powerful reporting tools to help providers analyze their financial transactions. If you’re a […]
EDI, EDISS Connect, Outsourced Billing, Revenue Cycle Management, Revenue Cycle Optimization
Are billing companies worth it? Often, yes, though the answer depends on arithmetic you can run on your own numbers in about ten minutes. A billing company takes a share of what you collect, and that money has to come back to you as something real, either saved payroll or extra collections. If neither shows […]
Coding and Billing, Outsourced Billing, Outsourced Medical Billing
Many questions exist in the medical billing and coding industry because it is a detailed and fast-changing field which requires a high level of accuracy and attention to detail. The healthcare industry is dynamic and is subject to frequent changes in laws, regulations, and insurance policies, which can impact the billing and coding process. Additionally, […]
Billing Challenges, Claim Denials, ICD-10, Medical Biller, Medical Coder
A medical billing specialist is central to the healthcare industry. They are responsible for managing the financial side of healthcare, which includes submitting claims to insurance companies and following up on any denied claims. A medical billing specialist is responsible for submitting and following up on claims to insurance companies for payment for medical services […]
Healthcare Careers, Jobs in Healthcare, Medical Billing Career, Medical Billing Jobs, Medical Billing Specialist
Uber Health is now active in 28 states and Lyft Healthcare in 21, and both work through Medicaid managed care plans and NEMT brokers rather than through the consumer app most people already have on their phone. That’s a significant shift from a few years ago, when these platforms were still mostly pilot programs. If […]
Healthcare Transportation, Lyft Healthcare, Medical Appointments, Medical Transportation, NEMT Billing, Non-Emergency Medical Transportation, Uber HealthMedical Billing has its Difficulties Medical billing is a detailed process that involves various steps to ensure that healthcare providers receive payment for their services. Onboarding a new medical billing system can be a daunting task, but it can also bring about significant improvements in the efficiency and accuracy of the billing process. Examples of […]
Billing Accuracy, Billing Software, Medical Billing Onboarding, Outsourced Billing
The Medicare and Medicaid programs provide crucial support to millions of Americans, offering access to healthcare services for those who may not otherwise be able to afford it. Unfortunately, these programs are also vulnerable to fraud, with criminals exploiting the system to enrich themselves at the expense of taxpayers and patients. Medicare fraud and Medicaid […]
Medicaid, Medicare, Phantom billing, Upcoding, Whistleblower Protection Act
Uncompensated care cost U.S. hospitals close to $745 billion between 2000 and 2022, and the number keeps climbing. Some of that spike traces back to Medicaid redeterminations that resumed in 2023, when states rechecked eligibility for the first time since the pandemic and more than 19 million people lost coverage. A patient who had Medicaid […]
Charity Care, Healthcare, Healthcare Debt, Medical Care, Medical Charity, Uncompensated Healthcare
Updated October 2026 Medwave first published this page in December 2022, the same month HHS proposed a national standard for electronic claim attachments. That proposal sat for more than three years. The final rule appeared in the Federal Register on March 24, 2026, and every HIPAA covered entity now has until May 26, 2028 to […]
CAQH Index, Denial Management, Electronic Claims, Medical Billing Software, RCM