RCM Intelligence Articles
Actionable billing intelligence for revenue cycle professionals. Specific codes, specific payers, specific dollars.
Modifier 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