RCM Intelligence Articles
Actionable billing intelligence for revenue cycle professionals. Specific codes, specific payers, specific dollars.
Medicare outpatient observation billing: how status, time, and discharge-day documentation determine payment under the hospital claim rules
Medicare observation payment turns on status support, hospital outpatient claim structure, and discharge-day documentation that can stand up to review.
July 27, 2026 Reimbursement StrategyHow CMS Defines and Applies Average Sales Price (ASP) and Sequestration Adjustments in Medicare Part B Drug Reimbursement
CMS uses Average Sales Price (ASP) and sequestration to determine Medicare Part B drug payment. Here’s what billing teams need to know.
July 20, 2026 E M DocumentationE/M Documentation for Telehealth Follow‑Up Visits: How CMS Defines Patient Status, Time, and Required Elements for Audit Support
CMS telehealth E/M documentation rules hinge on time, medical decision making, and clear patient status notes for audit support.
July 16, 2026 Denial AppealsAppealing Medical Necessity Denials for Infusion Therapy: How LCDs, Prior Authorization, and Documentation Requirements Define Covered Drug Administration Services
Infusion therapy denials often turn on LCD interpretation and documentation gaps. Here’s how to appeal effectively under 2026 payer analytics.
July 16, 2026 Modifier UsageModifier 52 for reduced services: how CMS defines partial procedures, required operative report elements, and correct claim reporting
Coding errors with modifier 52 trigger payer audits and underpayment risks. Learn CMS’s rules, documentation standards, and compliant reporting practices.
July 14, 2026 E M DocumentationTime-Based Versus MDM E/M Billing: How CMS Defines Total Time, Face-to-Face Activities, and Required Provider Documentation
CMS defines E/M coding by either time or medical decision-making. Here’s how total time, face-to-face work, and documentation must align under 2026 rules.
July 7, 2026 Modifier UsageGlobal surgical package modifiers 24, 58, 78, and 79: how CMS defines related versus unrelated postoperative services and documentation requirements
How CMS defines related vs. unrelated post-op services and documentation for modifiers 24, 58, 78, and 79 under the surgical global package.
July 7, 2026 Reimbursement StrategyHow CMS Defines and Applies the Physician Fee Schedule Conversion Factor and RVU Components in Professional Claim Reimbursement
CMS sets physician reimbursement using RVUs multiplied by a conversion factor. Here’s how those components shape a professional claim’s payment.
June 30, 2026 Prior AuthHow the CMS Interoperability and Prior Authorization Rule Defines Electronic PA Response Times, Data Exchange, and Payer Documentation Obligations
CMS's Interoperability and Prior Authorization Rule enforces faster electronic prior auth responses and strict data-sharing duties for payers.
June 30, 2026 Payer IntelligenceUnderstanding TRICARE’s Incident‑To and Supervision Requirements: How Provider Type, Setting, and Documentation Determine Claim Eligibility and Payment
TRICARE’s incident‑to and supervision rules make or break payment eligibility. Here’s how provider type, setting, and documentation drive compliance.
June 30, 2026 Coding ComplianceIncident‑To Billing for Non‑Physician Practitioners: How CMS Defines Direct Supervision, Plan of Care Documentation, and Split‑Visit Eligibility
CMS rules for incident‑to billing hinge on direct supervision, plan‑of‑care documentation, and split‑visit compliance — here's how to keep claims clean.
June 30, 2026 Audit Defense2026 Medicare and Commercial Payer Audits Target Physical Therapy Billing (CPT 97110‑97530): Defending Medical Necessity, Visit Frequency, and Modifier KX Documentation
CMS and commercial payers are ramping up 2026 audits on PT codes 97110-97530, scrutinizing KX modifier use and therapy visit frequency.
June 24, 2026 Audit Defense2026 CMS and Commercial Payer Audits Target Prolonged Services (CPT 99417, G2212): Documentation Standards, Time Tracking, and Modifier 25‑Related Overlap Risks
CMS and commercial payers are auditing prolonged services CPT 99417 and G2212 in 2026, focusing on documentation, time tracking, and modifier 25 overlap.
June 23, 2026 Modifier UsageModifier 26 vs TC in 2026 radiology and cardiology claims: preventing split‑billing errors under updated CMS and commercial payer payment rules
How CMS rule shifts and payer policy changes in 2026 are reshaping modifier 26 and TC billing for radiology and cardiology claims.
June 17, 2026 Modifier UsageModifier 25 under 2026 payer scrutiny: documenting same‑day E/M and minor procedure claims to avoid UHC and CMS audit denials
Modifier 25 claims are under renewed payer review in 2026. Here’s how to align documentation for same-day E/M and minor procedures to avoid denials.
June 17, 2026 Modifier UsageModifier 59 vs XU in 2026 Laboratory and Pathology Claims: Preventing NCCI Edit Denials Under Updated Payer Bundling Policies
In 2026, CMS NCCI updates and payer edits make correct use of modifier 59 vs XU critical for laboratory and pathology claim payment integrity.
June 14, 2026 Denial Appeals2026 Medicare Advantage and Commercial Payer Denials for Botox Injections (CPT 64612‑64616): Navigating Medical Necessity, Frequency Limits, and Prior Authorization Appeals
Medicare Advantage and commercial denials for Botox (CPT 64612‑64616) hinge on documentation, frequency, and prior auth alignment for 2026 claims.
June 14, 2026 Payer Intelligence2026 Aetna and UHC Claim Denials for Preventive vs Diagnostic Colonoscopy (CPT 45378‑45385): Coding, Modifier 33 Usage, and Patient Cost‑Share Disputes
Aetna and UHC denials for preventive vs diagnostic colonoscopy hinge on Modifier 33 and documentation. Avoid cost‑share disputes by clarifying intent at scheduling.
June 12, 2026