Medical Billing Services in California – What Practices Should Look For
California medical billing has its own complications: 58 county Medi-Cal Mental Health Plans, ongoing CalAIM code changes, AB 72 out-of-network rules, Knox-Keene concurrent review intensity, and telehealth modifier discipline. Out-of-state billing companies routinely miss these. Here are the seven questions every California practice should ask before hiring a billing vendor, the red flags to avoid, and what good California billing looks like.
Medical Billing vs Medical Coding: What’s the Difference?
Medical billing and medical coding are closely connected but serve different roles in the healthcare revenue cycle. While coding translates patient records into standardized codes, billing turns those codes into insurance claims and payments. Understanding the difference helps healthcare providers improve accuracy, compliance, and financial efficiency.
My Path Towards a Career in Medical Billing
Outline: A passing conversation in a doctor’s office planted a seed that would grow into my career—one I never saw coming. Medical billing, at first, felt like a foreign language, but I was intrigued by how it connected patients, providers, and insurers. Little did I know that this complex system would soon become my passion. […]
Medical Billing for Laboratories: Where Revenue Leaks and How to Stop It
Laboratory billing operates under its own rules: CLFS rates under PAMA pressure, NCD/LCD coverage constraints, the 14-Day Rule, modifier complexity, and molecular billing infrastructure. Labs that hire generalist billing support typically leak 8 to 15 percent of potential revenue annually. Here is where lab revenue leaks, why molecular billing needs its own workflow, and what works.
Medical Billing for Eating Disorder Treatment: Why It’s So Complex and How to Get Paid
Eating disorder treatment billing is one of the hardest specialties in behavioral health. Parity enforcement is uneven, payer level-of-care criteria do not match clinical guidelines, and denial volume is high. Treatment centers that get paid consistently document against payer criteria, run concurrent review on schedule, and prepare for every peer-to-peer. Here is what makes ED billing so complex and what works.
Medical Billing for Surgery Centers – What Makes ASC Billing Different and How to Get Paid
ASC billing operates under its own rules: ASC Payment System indicators, multi-procedure discounts, implant pass-through, and a specific modifier set. ASCs that hire generalist billing support typically leak 5 to 12 percent of facility revenue. Here is what makes ASC billing structurally different from physician and hospital billing, and what works in centers that get paid consistently.
Physician Billing: How Independent Practices Get Paid (and Why It Goes Wrong)
Physician billing covers the professional-fee side of healthcare reimbursement, distinct from facility billing. Independent practices typically leak 5 to 10 percent of potential revenue to E/M under-coding, modifier 25 errors, global period confusion, place-of-service mistakes, and incident-to gaps. Here is what physician billing is, where it goes wrong, and what good operations look like.
Mental Health Billing Services: What Practices Need to Know to Get Paid
Mental health billing is structurally harder than general medical billing: parity enforcement varies, level-of-care criteria conflict, concurrent review is aggressive, and behavioral health carve-outs add a second payer layer. Practices that get paid consistently build billing around criteria-aligned documentation, scheduled concurrent review, and granular denial analysis. Here is what to look for in a mental health billing service.
Substance Abuse Billing Services for Treatment Centers
Substance abuse billing carries more complexity than standard medical billing. Between HCPCS codes for residential and intensive outpatient treatment, Medicaid carve-outs that vary by state, and 42 CFR Part 2 confidentiality requirements, addiction treatment centers face a billing environment that general billing teams are not equipped to handle. Here is what this guide covers: Why […]
How Does the Medical Billing Process Work? (10 Steps Explained)
The medical billing process is a 10-step sequence that moves a patient encounter from registration to reimbursement. In behavioral health, each step carries additional complexity from time-based coding, prior authorization timelines, and payer-specific rules. Here is what this guide covers: Patient registration and insurance verification Eligibility and benefits check Medical coding (ICD-10, CPT, HCPCS) Charge […]
