Best Medical Billing

Medical billing articles

Denial resolution, payer policy, coding references and revenue cycle operations.

151 articles · page 5 of 8

  • How to Master CAQH Attestation Cycles and Avoid Credentialing Denials

    Missing your 120-day CAQH attestation deadline halts credentialing and triggers out-of-network claim denials. Learn how to manage ProView updates, handle expired documents, and build a foolproof re-attestation workflow for your practice.

    September 14, 202610 min read

  • Professional Medical Coding Services | AAPC & AHIMA Certified

    Outsource your coding to certified AAPC and AHIMA professionals to reduce claim denials, speed up reimbursement, and ensure full compliance with 2026 Medicare and commercial payer guidelines.

    September 14, 202610 min read

  • VA Community Care Prior Authorization & Billing Guide (2026)

    Treating Veterans means wrestling with the VA Community Care Network (CCN). Between Optum, TriWest, and the HSRM portal, navigating the rules requires strict discipline. Here is how to keep your authorizations clean, your clinicals uploaded, and your claims paid in 2026.

    September 13, 20269 min read

  • MetroPlus Billing Guide: Timelines, Rules, and Claims

    MetroPlus is New York City's public option powerhouse, covering over 700,000 residents. But their 120-day filing window and strict OPRA enrollment rules leave unprepared billers with costly denials. Here is exactly how to submit, correct, and appeal MetroPlus claims.

    September 13, 20268 min read

  • Mastering Prior Authorization for MRI Claims in 2026

    Securing an MRI authorization usually means fighting through automated payer portals like eviCore or Carelon. Here is how your billing team can bypass the endless pending statuses, prove medical necessity, and cut your clinic's MRI denial rate.

    September 13, 20269 min read

  • Fixing the PR-49 Denial: Routine Exam Exclusions and ABN Rules

    When payers deny a claim for non-covered routine care, they drop a PR-49 on your remittance advice. Before you blindly bill the patient, you need to check for Z-code mismatches, missing carve-out information, and valid ABNs. Here is how to fix the coding and collect your money.

    September 13, 20269 min read

  • Tricare Prior Authorization Requirements: The 2026 Guide

    Tricare authorizations can delay care and tank your revenue if you do not know the region-specific rules. Here is how to handle authorizations for Tricare Prime, Select, and Active Duty Service Members without losing your mind.

    September 12, 202610 min read

  • Mastering the CMS 855R Form: Reassigning Medicare Benefits in 2026

    Before a newly hired physician can bill under your group's NPI, they must reassign their billing rights. Here is exactly how to submit and track the CMS-855R application to keep your revenue cycle moving.

    September 12, 20269 min read

  • Cracking the Code: How to Fix the Top Claim Denials in 2026

    Denials are chewing up practice margins. From front-end eligibility failures and prior authorization mismatches to aggressive modifier audits, here is a detailed breakdown of why payers are rejecting your claims this year and the exact RCM workflows you need to get paid.

    September 12, 20268 min read

  • Holding Payers Accountable: The CMS Prior Authorization 7-Day Rule in Practice

    We are nine months into the CMS mandate capping standard prior auths at seven calendar days. Here is how your billing team can actually hold Medicare Advantage and Medicaid plans accountable to the deadline, bypass the clinical information loophole, and get claims approved.

    September 12, 20268 min read

  • Ambetter Timely Filing Limit & Billing Guide (2026)

    Ambetter claims demand state-specific precision. Centene's Marketplace plans frequently deny over delayed submissions, prior authorization gaps, and enrollment errors. Learn the exact 2026 filing windows, how to credential effectively, and tactics to overturn denials.

    September 11, 202610 min read

  • CO-4 Denial Code: Fixing Inconsistent & Missing Modifiers

    A CO-4 denial means your procedure code and modifier don't match up—or a mandatory modifier is completely missing. Here is the exact workflow to identify the coding error, append the right modifier, and push the corrected claim through.

    September 11, 20269 min read

  • Mastering Substitute Physician Billing: Q5, Q6, and the 60-Day Rule in 2026

    When a physician steps away and a colleague covers their patients, billing under the regular doctor's NPI keeps cash flowing. Here is exactly how to manage substitute billing compliance, the 60-day limit, and commercial payer quirks in 2026.

    September 11, 20268 min read

  • Building a Denial Tracking Spreadsheet That Actually Recovers Revenue

    A basic Excel log won't cut it when payers tighten their appeal windows. Here is the exact architecture your denial log needs to spot root causes, assign workflows, and recover cash before the clock runs out in 2026.

    September 10, 20267 min read

  • Stop Letting Payers Stall: Actionable Steps for the 2026 Prior Auth Rules

    The CMS-0057-F rule finally restricts payer turnaround times to 72 hours for urgent and seven calendar days for standard requests. Here is how your billing team can enforce the new clock.

    September 10, 20269 min read

  • CO-170 Denial Code: Provider Type & Taxonomy Mismatches

    When you see CO-170, the payer's system thinks your provider isn't qualified to perform the billed service. Here is how to fix taxonomy mismatches, correct mid-level modifiers, and prove state scope-of-practice to get the claim paid.

    September 10, 20269 min read

  • Outsource Provider Credentialing Services | Best Medical Billing

    Uncredentialed providers bleed practice revenue. We manage the entire credentialing and payer enrollment lifecycle—from CAQH setup to contract execution—so your doctors can start billing on day one without risking out-of-network denials.

    September 10, 202610 min read

  • Surviving the 2026 Re-Credentialing Crunch: Timelines, PECOS, and CAQH Rules

    Letting a provider's credentialing lapse means instant claim denials. Learn exactly how to manage CAQH attestations, PECOS revalidation, and commercial payer re-credentialing timelines in 2026 to protect your cash flow.

    September 9, 20269 min read

  • Medical Chart Auditing Services | Stop Undercoding & Compliance Risks

    Stop guessing whether your providers are documenting to the current 2026 standards. Our certified auditors find undercoding, compliance risks, and missed revenue before the payers do.

    September 9, 20268 min read

  • Winning the Medicare Advantage Prior Authorization Game Under 2026 Rules

    Medicare Advantage plans are notorious for aggressive prior authorization requirements. Here is how to navigate the 2026 CMS timeline rules, force faster decisions, and build an internal workflow that actually gets your high-dollar procedures approved.

    September 9, 20269 min read