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Medical Billing & Claims Management
How claims move from charge entry to payment: clean claim submission, rejections, payer follow-up, and the billing workflows that keep cash flowing.
73 guides
Prior Authorization in Medical Billing: Process and 2026 Rules
How prior authorization works in medical billing, what changed for covered payers in 2026, and how a practice can keep requests from stalling.
POS 11 vs POS 22: Office vs Hospital Outpatient Billing
POS 11 is the office, POS 22 is a hospital's main campus outpatient department, and POS 19 is the off-campus one. Here is how each changes the Medicare rate on...
Understanding Medical Expense Reimbursement Plans (MERPs): A Comprehensive Guide
Discover how MERPs help employees manage healthcare costs and provide tax benefits for employers. Learn more today!
Medical Claim Forms: CMS-1500 vs UB-04 vs 837 Explained
Which medical claim form applies to your billing? A plain guide to the CMS-1500, UB-04 and 837, how paper and electronic claims relate, and what Medicare expects.
Medical Billing vs Medical Coding: What Each Does and Who You Need
Coding turns a visit into codes. Billing turns those codes into a paid claim. Here is how they differ, how they hand off, and how to decide who should do...
Timely Filing Limits: Medicare, Medicaid and Commercial Payers
Timely filing limits depend on the payer, not just the state. See where Medicare, Medicaid and commercial limits come from and how to keep claims from aging out.
Understanding Medical Billing Cycles: A Comprehensive Guide
Learn the essential steps of the medical billing cycle and how to optimize revenue cycle management for your healthcare practice.
Understanding Medical Billing Advocates: Your Comprehensive Guide to Navigating Healthcare Costs
Discover how medical billing advocates simplify bills, save you money, and reduce stress in healthcare.
J-Codes in Medical Billing: Units, JW/JZ Modifiers and NDCs
J-codes name the drug and the billing unit on a claim line. Learn how to count units, when JW and JZ apply, and when the NDC is needed.
Institutional vs Professional Claims: UB-04 vs CMS-1500 Explained
Institutional vs professional claims differ by who bills and which form carries the bill. Here is how the UB-04 (837I) and CMS-1500 (837P) compare, and why one visit can need...
Hospital vs Professional Billing: Facility and Physician Claims
A hospital stay or visit usually produces two bills: one from the facility and one from the clinician. Here is who bills what, on which claim, and how Medicare pays...
Understanding HCC (Hierarchical Risk Adjustment) for Enhanced Coding and Care
Explore HCC coding's importance, benefits, and best practices to improve reimbursement and patient care in healthcare.
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