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Billing Changes

Expert guides, legislative updates, and actionable billing tips - built for the specialties we serve.

Top 5 Reasons Mental Health Claims Get Denied - And How to Prevent Them

Mental health claims face some of the highest denial rates in healthcare. Between time-based coding requirements, parity law nuances, and telehealth-specific rules, behavioral health practices are leaving money on the table - often without realizing it. Here are the five most common reasons mental health claims get denied, and exactly what your team can do to prevent each one.

6 min readMay 8, 2026

Behavioral Health

Mental Health Parity Laws in 2025: What Billing Teams Need to Know

Mental health parity legislation continues to evolve in 2025, with new enforcement mechanisms and reporting requirements that directly impact how behavioral health practices get paid. If your billing team isn't tracking these changes, you're at risk of both lost revenue and compliance violations.

7 min readMay 2, 2026

Long Term Care

PDPM Billing: Common Documentation Errors That Cost Skilled Nursing Facilities Thousands

The Patient-Driven Payment Model (PDPM) fundamentally changed how skilled nursing facilities are reimbursed. But many SNFs are still making documentation errors that systematically reduce their PDPM scores - and their revenue. Here are the most common mistakes and how to fix them.

7 min readApr 27, 2026

Long Term Care

Medicare vs Medicaid in Long Term Care: A Billing Cheat Sheet for Administrators

Billing in long term care means navigating two fundamentally different programs - often for the same patient. Medicare and Medicaid have different eligibility rules, covered services, payment models, and claim submission processes. This cheat sheet breaks down the key differences and shows you how to avoid the most expensive crossover billing mistakes.

8 min readApr 22, 2026

General Practice

E&M Code Changes: Are You Billing at the Right Level in 2025?

Evaluation and Management (E&M) codes are the bread and butter of general practice revenue. But persistent changes to documentation requirements, combined with aggressive payer downcoding, mean that many practices are billing at the wrong level - either leaving money on the table through undercoding or risking audits through overcoding. Here's where things stand in 2025.

6 min readApr 18, 2026

General Practice

How to Reduce Your Practice's Claim Denial Rate Below 5%

The average claim denial rate across healthcare sits between 5% and 10%. For general practices with limited billing staff, it's often higher. Every denied claim costs $25–50 to rework and delays payment by 30–90 days. Here's a systematic approach to getting your denial rate below 5% - and keeping it there.

7 min readApr 14, 2026

Legislative Updates

CMS 2025 Physician Fee Schedule: What Changed and What It Means for Your Revenue

The CMS Physician Fee Schedule (PFS) for 2025 brings a revised conversion factor, new billing codes, updated telehealth policies, and changes to several high-volume service valuations. Whether you run a solo practice or a multi-provider clinic, these changes directly affect your bottom line. Here's what you need to know.

8 min readApr 10, 2026

Billing Tips

The Hidden Cost of Undercoding: How Clinics Lose Revenue Without Knowing It

Overcoding gets audited. Undercoding just quietly drains your revenue. Many practices - especially those with compliance-cautious providers - systematically bill lower than the documentation supports. The result: hundreds of thousands of dollars in lost revenue annually, with no one noticing because the claims are accepted and paid.

6 min readApr 6, 2026

Billing Tips

AI in Medical Billing: Hype vs. Reality for Independent Practices

Every billing vendor now claims to be 'AI-powered.' But what does that actually mean for an independent practice with 3–10 providers? Is AI going to replace your billing team? Will it catch every error? Is it worth the investment? Let's separate the hype from the reality.

7 min readApr 2, 2026

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