Top CPT codes & modifiers for orthopedic billing—boost revenue with Prime RCM’s expert guide.
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Recoupment vs. Refund in medical billing: key differences explained by Prime RCM.
CPT Code 99211: Valid in 2025, bill for nurse visits with proper documentation. Learn more with Prime RCM.
Learn what a W-9 form in medical billing is, its purpose, and how it ensures compliance in healthcare billing.
What is a LOP in medical billing? Learn how a Letter of Protection ensures care without upfront costs.
Understand appeal limit vs. filing limit in medical billing to boost claims efficiency with Prime RCM.
Expert tips from Prime RCM to handle timely filing claim denials and recover revenue fast.
Understand timely filing limits in medical billing to avoid claim denials with Prime RCM’s guide.
LCD in Medical Billing explained: Learn its purpose and impact on claims with Prime RCM.
What is NCCI in medical billing? Learn about Medicare NCCI edits and the National Correct Coding Initiative with Prime RCM.
What is AR in medical billing? Learn its meaning, importance, and role in healthcare revenue management.
EDI in medical billing streamlines claims and cuts costs. Discover its power with Prime RCM’s expert insights.
Discover what authorization in medical billing means and how Prime RCM ensures smooth processing for providers.
Credentialing in medical billing ensures providers are verified for insurance networks. Learn more with Prime RCM.
What’s a J-code in medical billing? Prime RCM breaks down these HCPCS codes for drugs and accurate billing.
Discover the global period in medical billing: a key timeframe for surgical care billing explained by Prime RCM
Upcoding in medical billing inflates claims for higher pay. Learn its definition, examples & risks with Prime RCM.
Learn the importance of NPI in medical billing, its benefits, and how healthcare providers can obtain one.
Understand unbundling in medical billing, its impact, and how to prevent unbundled claims. Learn key strategies to manage billing errors.
Sequestration in medical billing cuts Medicare payments 2%. Prime RCM breaks it down and helps providers cope.
The CLIA number is crucial for laboratory billing, ensuring compliance and reimbursement eligibility.
RVU means Relative Value Unit. It sets doctor pay in medical billing. Prime RCM helps you understand and maximize it.
Discover what DRG in medical billing means and how it helps streamline hospital payments and patient care.
Discover what NDC codes are, their role in billing, and why they’re crucial for accurate claims and reimbursement.
Capitation in medical billing is a fixed payment model where providers receive per-member-per-month payments.
A clearinghouse in medical billing processes and transmits error-free claims between healthcare providers and payers.
Coordination of Benefits (COB) ensures correct insurance payments, prevents duplicate billing, and streamlines claims.
Discover what modifiers in medical billing are and how they ensure accurate claims and reimbursements.
Understand what an itemized bill in medical billing is and how it helps you manage healthcare costs.
Learn what ABN in medical billing is, its importance, and when it should be signed for compliance.
Discover the importance of fee schedules in medical billing, ensuring transparency, accuracy, and fair reimbursements.
TOS in medical billing refers to codes that classify healthcare services for accurate billing and reimbursement.
Learn the process of claims payment optimization to reduce denials, improve cash flow, and enhance efficiency.
The ERA in medical billing ensures efficiency, accuracy, and transparency to streamline payments and reduce claim denials.
The Golden Rule in medical billing ensures accuracy, compliance, and transparency to prevent claim denials.
The 10-step medical billing process ensures accuracy, compliance, and transparency to prevent claim issues.
In the world of medical billing and coding, CPT codes (Current Procedural Terminology) play a critical role in ensuring that healthcare providers get reimbursed accurately for the services they render. Understanding CPT codes, types of CPT codes, CPT billing codes, and CPT code ranges is essential for medical professionals, billers, and coders. At Prime RCM, …
Medical bills can pile up quickly, and if you’re struggling to make payments, you might wonder what happens if you don’t pay them. Ignoring medical bills can have serious financial and legal consequences. In this article, we’ll break down the potential outcomes of unpaid medical bills, explore the impact on your financial health, and provide …
When it comes to healthcare coverage, particularly for individuals with limited income, Medicaid Spenddown is an essential program that helps those who exceed Medicaid’s income limit qualify for coverage. Understanding how this process works can be crucial for patients and medical providers alike. At Prime RCM, the top-rated medical billing and credentialing company in the …
In medical billing, denials can be one of the most frustrating challenges healthcare providers face. Understanding what is denial in medical billing and how to manage it effectively is essential for ensuring that providers are paid for the services they provide. Denials can result in significant delays in payments, affecting a practice's cash flow and …
In the healthcare industry, proper billing and coding are essential for accurate insurance reimbursements and efficient revenue cycle management. Medical billers and coders play a vital role in ensuring that healthcare providers are paid for the services they provide. Understanding the duties and responsibilities of medical billers and coders can help healthcare organizations streamline their …
Medical billing can be a confusing and frustrating process for patients and healthcare providers alike. From unexpected charges to discrepancies in billing, it’s not uncommon for patients to face issues with their medical bills. Fortunately, if you find yourself in a situation where the charges don’t seem right or are more than you expected, there …
In the complex world of medical billing, understanding the Explanation of Benefits (EOB) is essential for both healthcare providers and patients. The EOB plays a crucial role in the reimbursement process, outlining how an insurance company processed a claim. For medical providers, it’s vital to comprehend what an EOB entails and how it impacts their …
The UB-04 claim form, also known as the CMS-1450 form, is a standardized claim form used by institutional healthcare providers to bill insurance companies for medical services rendered. Developed by the National Uniform Billing Committee (NUBC), the UB-04 form is essential in the healthcare billing process, particularly for submitting inpatient claims, outpatient claims, Medicare claims, …
In the medical billing world, understanding the difference between institutional claims and professional claims is essential for accurate billing and revenue cycle management. Both types of claims are crucial in healthcare, but they serve different purposes and require distinct billing processes. This guide will help clarify the differences between institutional claims and professional claims, highlighting …
In the complex world of medical billing, payment posting plays a pivotal role in ensuring that healthcare providers are compensated accurately and promptly for the services they render. Understanding the nuances of payment posting in medical billing is essential for maintaining financial health and compliance within medical practices. This comprehensive guide will explain what payment …
In today's healthcare landscape, businesses and organizations constantly seek ways to manage healthcare costs while providing valuable employee benefits. The Medical Expense Reimbursement Plan (MERP) is one of the most effective solutions. This guide will explain the concept of MERP, how it works, and its benefits for both employers and employees. We'll also cover various …
In the fast-paced world of healthcare, the accuracy and timeliness of claim submissions are crucial for ensuring that providers receive prompt reimbursements for their services. One term that frequently appears in the medical billing industry is "clean claim." But what exactly is a clean claim, and why is it important? In this article, we will …
Medical billing involves the use of various modifiers to ensure that claims accurately reflect the services provided to patients. Among the most commonly used modifiers are 59, 25, and 91. These modifiers play a critical role in avoiding claim denials, ensuring proper reimbursement, and communicating essential information to insurance payers. According to a recent industry …
In medical billing, a Superbill plays a crucial role in documenting patient encounters and ensuring that healthcare providers are reimbursed for the services they render. According to recent industry reports, more than 70% of healthcare providers use Superbills as a primary document for submitting claims to insurance companies. A Superbill is a detailed document that …
Medical billing involves various complex processes and terminologies, one of which is recoupment. In simple terms, recoupment refers to the process by which insurance companies or payers recover overpayments made to healthcare providers. While this is a common practice in the healthcare industry, it can significantly impact a provider's revenue if not managed properly. In …
Medical claim forms are essential tools in the healthcare billing process, used to submit information about services provided by healthcare professionals to insurance companies for reimbursement. There are several types of medical claim forms, each serving a specific purpose in different healthcare settings. In this article, we will explore the most commonly used medical claim …
In the complex world of medical billing, healthcare providers often come across various terminologies that play a crucial role in managing payments and claims. One such term is IPA, which stands for Independent Practice Association. In this article, we will dive into what IPA means in medical billing, how it impacts healthcare providers, the benefits …
Medical billing can be complex, with numerous codes and adjustments that healthcare providers must understand to ensure accurate claim submissions. One of the most common adjustment codes encountered in medical billing is CO-45. In this article, we will explore what CO-45 means, how it affects healthcare providers, why it is applied to claims, and how …
When it comes to medical billing and coding, healthcare providers need to be familiar with various codes and terminologies to ensure accurate claim submissions and reimbursements. One essential code that plays a significant role in this process is POS 11. In this article, we'll explore what POS 11 means, its importance in medical billing, how …
Revenue cycle management is a critical aspect of healthcare operations, and one essential element that healthcare providers often encounter is the revenue code in medical billing. For medical practices, clinics, hospitals, and specialty providers, understanding revenue codes is crucial to ensuring accurate claim submissions and faster reimbursements. In this article, we will explore what a …
In the ever-evolving world of medical billing and coding, accuracy, compliance, and efficiency are essential for healthcare providers to ensure smooth revenue cycle management. One crucial element often overlooked is the TPI number in medical billing. This article will explore what a TPI number is, why it matters, and how it plays a vital role …
Communicating sensitive health information to patients can be challenging. However, using the right channels and choosing appropriate words can make this task easier and more secure.
For any physician, accurately calculating patient responsibility is essential for running an efficient practice.
Communication is the exchange of information between two or more individuals. Effective communication not only leaves people satisfied but also reduces potential conflicts, which is particularly crucial in the healthcare sector.
