A claim for a 45-minute therapy session gets denied in Ohio, and the reason has nothing to do with the clinical note. The provider enrolled under a category that
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A patient returns for a follow-up visit with the same insurance card as last time, and the front desk checks them in. Three weeks later the claim comes back
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A Michigan BCBA can hold valid BACB certification and still be unable to bill a single claim. The state treats certification and licensure as separate credentials, and every payer
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A therapy clinic in Lansing sees a crash patient for an hour. It bills the auto insurer four units. The check that comes back is about a third lighter
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A sleep apnea appliance claim can fail long before a reviewer looks at the device. The order may postdate the sleep study report, the CPAP history may be missing,
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MICHIGAN MEDICAID BILLING GUIDE Michigan Medicaid began reimbursing community health worker (CHW) services on January 1, 2024. Michigan CHWs had been doing this work for decades before that date.
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A pediatric speech-language pathology practice in Texas can be full, have a clean schedule, and still not get paid by Medicaid for months. Therapy is good. It’s the paperwork
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Since Jan. 1, 2023, Medi-Cal has covered doula care. After three years, the benefit pays a doula up to $3,152.65 for a single vaginal birth client under the fee-for-service
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The cause of a chest CT scan requested to monitor a lung nodule and billed as a screening scan will typically be found in a single code choice. The
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The A1C test CPT code seems to be the easiest line on a lab claim. One code, one outcome. But that simplicity is also why mistakes go unnoticed until
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