POS 22 in Medical Billing: What It Means In the U.S. healthcare system, billing codes are used to show where and how medical care was given. One of these codes is POS 22, which stands for “Outpatient Hospital.” This code matters because it affects how doctors and hospitals get paid, and how much patients owe. … Read more
In today’s healthcare landscape, precision matters more than ever. And nowhere is that more true than in pharmacy-related billing. The National Drug Code (NDC) might seem like a random string of numbers, but it plays a central role in ensuring accurate drug identification, payer compliance, and timely reimbursement. Yet many billing errors stem from NDC … Read more
Rejection in medical billing is more than just an inconvenience—it’s a revenue disruptor, a productivity killer, and often, a red flag of deeper workflow issues. If you’ve ever received a “claim rejected” notice from a payer, you know the frustration. But here’s the thing: rejections are preventable. You just need to understand what they are, … Read more
In the world of medical billing, the tiniest details can make the biggest difference—especially when it comes to modifiers. Two of the most commonly misunderstood are modifier 25 and modifier 59. To the untrained eye, they may seem interchangeable. But in reality, using the wrong one could trigger denials, audits, or even compliance issues. If … Read more
While medical coders and billers both contribute to the healthcare revenue cycle, their roles serve different but complementary purposes. Medical coders translate doctors’ notes, test results, and procedures into standardized codes like ICD-10 and CPT. These codes are essential for insurance documentation and accurate patient records. In contrast, medical billers take those codes and prepare … Read more
Whether you’re a student learning medical billing, a healthcare provider, or a patient reviewing your surgical charges, understanding the difference between global periods and postoperative care billing can help you avoid confusion and billing errors. Where to Learn About Global and Postoperative Periods If you want reliable, up-to-date information on surgical billing rules, start with … Read more
In medical billing, understanding the tools used to document and track patient services is crucial. Two commonly used documents are the superbill and the charge slip. While they may seem similar, each plays a unique role in the billing process. A superbill is a comprehensive, itemized form used by healthcare providers to capture detailed information … Read more
In medical billing, the terms “clean claim” and “dirty claim” are more than just jargon, they directly affect how quickly healthcare providers get paid. A clean claim is one that is accurately completed, properly coded, and submitted in compliance with the payer’s guidelines. It processes smoothly and typically results in timely payment. A dirty claim, … Read more
In medical billing, authorization and referral serve different purposes, though both are crucial for insurance coverage and patient care. Simply put, authorization is permission from the insurance company for a service, while a referral is a recommendation from a primary care provider (PCP) to see a specialist. Let’s break down the details to help you … Read more
Definition Understanding Reversals in Medical Billing Understanding Refunds in Medical Billing Quick Comparison: Reversal vs. Refund Aspect Reversal Refund Timing Before payment settles After payment is finalized Purpose Cancel wrong/unauthorized charges Return overpayment or correct billing errors Impact on Accounting Minimal correction needed Requires adjustments and audit trails Common Triggers Duplicates, wrong authorization Overbilling, service … Read more
