Insights & Resources
Practical guidance on revenue cycle, coding, compliance, and the business of healthcare.
Ask five people when critical care is billable and you will hear five answers. It is not the ICU, not the ventilator, and not a severe-sounding diagnosis — it is the patient's risk, the physician's work, and the qualifying time.
A global period is not a 10- or 90-day "do not bill" window, and it is not a free pass to add a modifier either. Here is what the surgical package actually covers, what it does not, and the six questions that settle any encounter.
"We can't bill it — the patient is still in the global." Sometimes that's right. Sometimes it hands away a medically necessary service that was never part of the surgery. Here's when Modifier 24 applies — and when it doesn't.
The consult isn't dead — but it depends on who's paying. Medicare stopped recognizing consultation codes in 2010; many commercial payers never followed. Billing every payer the same way costs practices money in both directions.
"I assumed prior authorization had been obtained." "I assumed the provider was credentialed." The assumptions that quietly delay payments, drive denials, and cost practices hundreds of thousands of dollars — and the verification habits that replace them.
Small modifier. Big consequences. Every month we review thousands of physician claims, and the same ten modifier mistakes keep surfacing — driving denials, underpayments, and audit risk. Here is what to watch for.
"I documented everything, so why wasn't it billed?" Documentation and billing work together, but they answer different questions — and understanding the difference improves reimbursement, reduces denials, and lowers compliance risk.
Why providers are being asked to reattest and revalidate their enrollment — and why the Treasury Department is suddenly involved.
And does anyone actually use it anyway? Why an up-to-date CAQH profile is one of the most important — and most overlooked — drivers of clean credentialing and on-time payment.
