What Is an Entity Code in Medical Billing? Types, Errors and Fixes
You submitted a clean claim. Everything looked right: the diagnosis codes, the procedure codes, the patient information. Then it came back rejected with a message that said “this code requires use of an entity code.” No further explanation. Just a rejection sitting in your queue costing you time and money. That’s one of the most […]
CPT Code 93306: Payer-Specific Compliance, Audit Defense and Denial Recovery Playbook [2026]
The average cardiology practice bills CPT code 93306 between 40 and 80 times per week. At roughly $220 per claim, that’s $450,000 to $900,000 in annual echocardiogram revenue from a single CPT code. Yet CMS Recovery Audit Contractor data shows that transthoracic echocardiography ranks among the top 10 most audited diagnostic services in Medicare, with […]
Eligibility Verification & Prior Authorization: Key Differences Every Healthcare Practice Must Know [2026]
A billing coordinator at a busy orthopedic practice picks up the phone and calls the insurance company. “I need to verify the patient’s eligibility for an MRI,” she says. The rep on the other end pauses, then asks: “Do you need eligibility verification or prior authorization?” The coordinator hesitates. Aren’t those the same thing? That […]
90834 CPT Code: Credential-Based Rates, Payer Rules, and Revenue Optimization for Therapy Practices [2026]
CPT Code: 90834 Description: Psychotherapy, 45 minutes with patient Time Range: 38 to 52 minutes face-to-face Setting: Outpatient (office, clinic, or telehealth) Telehealth Modifier: 95 (synchronous audio-video) 2026 Medicare Rate (Non-Facility): ~$113.90 (national average) Credential-Based Rate Range: MD/PhD ~$113 to $134 | LCSW/LPC ~$95 to $115 | LMFT/LMHC (Medicare) ~$85 (75% of psychologist rate) Eligible […]
12 Common Mistakes in Filling CMS 1500 Form and How to Fix Them
The most common mistakes in filling CMS 1500 form aren’t dramatic coding failures. They’re small, preventable errors: wrong patient demographics in Boxes 1 through 13, invalid ICD-10 or CPT codes, missing diagnosis pointers in Box 24E, incorrect NPI information, and missing modifiers in Box 24D. These mistakes silently drain your revenue and delay reimbursements week […]
POS 11 in Medical Billing: What It Means, When to Use It & How It Impacts Your Revenue in 2026
POS 11: Quick Reference Field Detail Code 11 CMS Name Office Full Name Place of Service 11 Setting Physician’s private practice, group practice, or standalone clinic Type Outpatient only (never inpatient) Payment Rate Non-facility (typically 10% to 40% higher than facility codes) CMS-1500 Location Box 24B 2026 Conversion Factor $33.40 (non-APM) / $33.57 (APM) Common […]
CPT Code 97162: Documentation, Billing & Compliance Guide for Healthcare Providers [2026]
CPT code 97162 is the AMA-designated billing code for a moderate-complexity physical therapy evaluation, requiring documented assessment of three or more body systems, one to two comorbidities affecting the plan of care, and moderate-level clinical decision-making for an evolving clinical presentation. But here’s what most coding guides miss: billing 97162 correctly isn’t just about knowing […]
Top 10 Clearinghouses in Medical Billing (2026): Pricing, Pros & Cons Compared
According to the CAQH 2025 Index report, the healthcare industry saved $258 billion in 2024 through electronic transactions. That number shows how critical HIPAA-compliant healthcare clearinghouses are to the revenue cycle. But one disruption that same year exposed how fragile the system really is. The February 2024 Change Healthcare cyberattack shut down electronic claims processing […]
Revenue Cycle Management Services in California [2026 Guide]
Key Takeaways Revenue cycle management services in California cover every financial step of a healthcare encounter: patient registration, eligibility verification, coding, claims submission, denial management, and final payment collection. In 2026, California providers face critical regulatory shifts, including AB 3275’s 30-day prompt pay mandate with 15% interest on late payments and Medi-Cal reimbursement increases to […]
10 Proven Benefits of Outsourcing Revenue Cycle Management in 2026
Healthcare finances in 2026 are under pressure from every direction. Staffing shortages have left billing departments running on fumes. Claim denial rates keep climbing. Operational costs continue rising while reimbursements stay flat or shrink. The Change Healthcare cyberattack made an already difficult situation worse. According to an AHA survey, 94% of hospitals were financially impacted […]