AI in Medical Billing: What Healthcare Providers Must Know in 2026
Artificial intelligence (AI) is now part of everyday life in healthcare. From scheduling tools to patient communication, AI is slowly finding its way into many administrative tasks — including medical billing. But here’s the truth many providers want to know: What can AI actually do for medical billing in 2026, and how should a normal […]
Read More
Understanding Sequestration in Medical Billing
Navigating the complexities of medical billing can be challenging for healthcare providers and billing professionals alike. One concept that significantly affects revenue cycles is sequestration in medical billing, a mandatory federal budget reduction that has reshaped how medical practices receive payments from Medicare. What is Sequestration in Medical Billing? Sequestration in medical billing refers to […]
Read More
What is a Guarantor in Medical Billing? A Complete Guide for Healthcare Providers
A patient leaves your office after a procedure. Your front desk staff collected their insurance information, but a few weeks later, you receive a denial. The reason? The claim was sent to the wrong responsible party. This common scenario highlights a critical, yet often misunderstood, element of the revenue cycle: the guarantor. Understanding what a […]
Read More
Understanding CPT Code for Cystolitholapaxy
Cystolitholapaxy is a minimally invasive urological procedure that uses endoscopic fragmentation and evacuation to remove bladder stones. For medical coders and urology practices, selecting the correct CPT code ensures proper reimbursement and compliance with payer requirements. Quick Answer CPT code selection for cystolitholapaxy depends on stone size: Both codes include cystoscopic visualization, stone fragmentation, and […]
Read More
Understanding CPT Code for Olecranon Bursectomy
What Is an Olecranon Bursectomy? The olecranon bursa sits over the bony tip of the elbow and reduces friction between skin and bone. When swelling, pain, or infection persists despite conservative care (aspiration, compression, antibiotics, activity modification), surgeons may remove the bursa through an open bursectomy. Primary CPT® Code You’ll Use Closely Related Scenarios (Choose […]
Read More
Guide to Accurate Coding for Pulmonary Function Tests
Proper coding for pulmonary function tests (PFTs) is vital for healthcare providers to secure accurate reimbursements and maintain compliance in medical billing. PFTs are diagnostic tools that assess lung function, aiding in the diagnosis and management of respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis. Each type of PFT requires […]
Read More
Understanding Medicare GA, GX, GY, GZ Modifiers for Accurate Billing
Navigating Medicare billing can be complex, especially when it comes to using modifiers like GA, GX, GY, and GZ. These modifiers play a critical role in ensuring accurate claims processing and reimbursement for healthcare providers. Misusing them can lead to claim denials or compliance issues. This guide clarifies the purpose of each modifier, when to […]
Read More
Understanding the ICD-10 Code for Abnormal EKG (R94.31)
Electrocardiograms (EKGs or ECGs) are a critical diagnostic tool in healthcare, offering a window into the heart’s electrical activity. They play a vital role in detecting and managing heart conditions early. If you’ve encountered the term “ICD-10 code for abnormal EKG,” you’re likely looking to understand what it signifies, when it’s used, and why it’s […]
Read More
Hospital Billing vs Professional Billing: What’s the Difference?
Ever stared at a medical bill and wondered why healthcare billing feels like rocket science? You’re not alone. Most healthcare providers get confused between hospital billing and professional billing – and honestly, who can blame them? Let’s clear this up once and for all, in plain English. Hospital Billing: It’s All About the “Where” Think […]
Read More
Top Occurrence Codes Used in SNF Billing: A Comprehensive Guide for Healthcare Providers
In the world of healthcare billing, Skilled Nursing Facilities (SNFs) face unique challenges when it comes to accurate claim submissions. One critical aspect that often determines the success of Medicare reimbursements is the proper use of occurrence codes. These codes help document key events in a patient’s care journey, ensuring compliance with Medicare guidelines and […]
Read More