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Claim denials are becoming harder to shrug off. Industry-wide, initial denial rates have climbed toward 12 percent, and a large share of those denied claims never get reworked at all — they just quietly become lost revenue. Multiply that by every claim your practice files in a year, and it adds up to real money [...]
2026 ICD-10 Update: The updated 2026 version of ICD-10 became effective on October 1, 2025. These are our two favorite sources for diagnosis codes. The CMS site (these are the official files): https://www.cms.gov/medicare/coding-billing/icd-10-codes Under 2026 ICD-10 CM & PCS files, download the file “2026 Code Tables, Tabular and Index (Zip).” The zip file contains a [...]
TELEMEDICINE CODING AND BILLING Providers and staff often ask about not only providing treatment to a patient electronically, but also about their time spent on following up with messages and phone calls with patients. To help, let’s break down the basic types of services that fall under telemedicine billing and coding. “TELEHEALTH VISITS” coding and [...]
Fully 40% of a practice’s problem claims are related to insurance eligibility. Insurance verification will reduce your denials. We cannot stress enough the importance of making insurance verification a part of every patient’s visit every time. Problems include: insurance company changes the ID number, patient changes employment and doesn’t know their new insurance, or [...]
Why was my claim denied? There are lots of reasons for claim denials, but most can be easily prevented. Here are a few simple steps that are imperative to reduce claim denials. Problem: Clerical Errors This is the number one reason that we believe claims are denied in the typical medical practice. Some potential problems: [...]
Why do you need my social security number? Do your patient intake forms still ask for a patient’s social security number (SSN)? Why? You don’t really need it. I know, you’re thinking, “But we’ve always asked for a patient’s SSN! The insurance company requires it!” Not true. If you look at the data in an electronic [...]
