Guides
Medical billing, answered. By people who do it every day.
Costs, denials, AR, New York rules and specialty coding. Each guide links to its sources.
Choosing a biller
- Medical billing company fees: percentage, per claim or flatHow medical billing companies charge: percentage, per claim or flat. What the percentage is a percentage of, and the fees to get in writing first.7 min read
- In-house biller vs billing company: the real cost on Long IslandWhat a medical biller costs on Long Island once you add benefits, software and cover for time off, and how that compares with a billing company’s fee.6 min read
- 12 questions to ask a medical billing companyTwelve questions to ask a medical billing company before you sign, why each matters and what a good answer sounds like. Printable checklist at the end.7 min read
Fixing lost revenue
- 10 common claim denials and how to stop themTen claim denials small practices see again and again, the codes they arrive with, and the front desk and billing steps that stop each one at the source.7 min read
- Denial codes explained: CO-16, CO-97, CO-197, PR-204 and moreWhat CO, PR, OA and PI mean, what 22 common claim adjustment reason codes say, and whether to correct, resubmit, reconsider or appeal each one.9 min read
- How to read an AR aging report, and what healthy looks likeWhat each aging bucket means, how to calculate days in AR two ways, why there is no free official benchmark, and how to set a baseline from your own data.7 min read
- Old AR: which unpaid claims are still worth chasingA triage rule for old AR: which unpaid claims still have an open filing or appeal window, which are dead, how to set a dollar floor, and NY debt rules.8 min read
- How to find underpaid claims on your ERAs (835s)An underpayment is an allowed amount below your contract, not just a low payment. How to read the 835, rule out normal reductions and dispute the rest.7 min read
- How to export your 835s and AR aging report from your EHRWhere to find your 835 remittance files and AR aging report in Epic, athenahealth, eClinicalWorks, NextGen, Tebra and five other systems, from vendor docs.7 min read
Specialty billing
- G2211 becomes modifier B1 in 2027: what changes and what doesn’tMedicare replaces add-on code G2211 with modifier B1 on January 1, 2027. Who qualifies, the modifier 25 limit, B2 for ACOs, and what to change now.7 min read
- Modifier 25 in 2027: physicals, procedures and the 80% ruleWhen modifier 25 applies, how to bill a physical and a problem visit together, what patients pay, and Medicare’s 2027 cut for same-day 0-day procedures.8 min read
- 90460 vs 90471: which vaccine administration code to billWhen to bill 90460 and 90461 instead of 90471 and 90472, how vaccine components are counted, and how NY Medicaid pays for VFC vaccine administration.7 min read
- Well-child and sick visit on the same day: how to bill bothWhen a problem at a checkup can be billed as its own visit with modifier 25, what the note must show, NY Medicaid and Child Health Plus rules, and copays.6 min read
- Prior authorization for echo and stress tests in New YorkWhich New York payers require prior auth for echo, stress echo and nuclear stress tests, who reviews them, and the deadlines plans must meet in 2026.6 min read
- Global surgery period billing: what’s included and modifiers 24, 25, 57 and 79How Medicare’s 0, 10 and 90-day global periods work, what the surgical package includes, when modifiers 24, 25, 57, 58, 78 and 79 apply, and 2027 changes.8 min read
- 90837 vs 90834: time rules, audits and 2027 Long Island ratesThe time ranges for 90832, 90834 and 90837, when 90785 applies, what auditors look for, telehealth rules for 2027 and Medicare rates for Long Island.7 min read
- The 8-minute rule: how to count PT units for Medicare and other plansHow Medicare’s 8-minute rule turns timed therapy minutes into units, with worked examples, CQ and CO rules, and the 2027 KX threshold of $2,540.8 min read
- Chiropractic billing: the AT modifier and 98940–98942When Medicare pays a chiropractor, how the AT, GA and GZ modifiers work, what the note must show for a subluxation, and how NY plans differ.8 min read
- Routine foot care billing: the Q7, Q8 and Q9 modifiersWhen Medicare pays for nail and callus care, how class findings pick the Q7, Q8 or Q9 modifier, the 60-day limit, and what NY claims need on them.8 min read
New York and Long Island
- Medical billing on Long Island: how to choose a billerChoosing a medical billing company on Long Island: the plans Nassau and Suffolk patients carry, the NY rules that apply to each, and what to ask a biller.6 min read
- New York medical billing rules other states don’t haveNew York’s 120-day filing floor, 30-day prompt pay, surprise bill IDR, eMedNY’s 90-day rule and medical debt limits, with the statute behind each one.10 min read
- Timely filing limits for New York payers, by planFiling, correction and appeal deadlines for Medicare, eMedNY, the Empire Plan, Anthem, UHC, Oxford, Aetna, Cigna, Emblem, Healthfirst, Fidelis and more.9 min read
- Credentialing in New York: how long it takes, plan by planNew York gives regulated plans 60 days to decide on a complete application. What that covers, NY Medicaid and Medicare enrollment, CAQH, and a checklist.8 min read
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