Every specialty we bill for, and what changes in each one
Two practices can bill the same payer in the same state and face different rules. This is the index of the specialties we work in, with the codes and payer patterns that actually decide whether a claim is paid.
Most billing problems are not billing problems. They are specialty problems that surface in billing.
A claim denied for medical necessity on an epidural injection is not a coding error. It is a payer policy and documentation question that should have been answered before the injection was scheduled. Moving that claim through a general billing queue does not fix it, because nobody in the queue owns the policy. Anesthesia bills in base units and time units. Pathology splits technical and professional components on surgical specimens. Behavioral health authorizes by units per week and expires quietly. The code set and the payer’s medical policy are different in each case, and so is the evidence the payer accepts.
Behavioral health and psychiatry
Authorization is the center of gravity here, because these services are approved per unit or per visit rather than per procedure.
Primary care and family practice
High volume, low unit value, and Medicare’s own rules for preventive visits. Small coding errors here cost repeatedly because they repeat every day.
Surgical specialties
Global periods, modifier sequencing and multiple procedure reduction decide the payment here. One wrong modifier can halve a claim that was coded correctly otherwise.
Medical specialties
Infusions, injections and drug codes drive the revenue, and prior authorization decides whether any of it is payable.
Therapy and rehabilitation
Billed by the minute, capped by the payer and renewed on a plan of care. The unit math decides the payment before the coding quality does.
Diagnostics and imaging
Technical and professional components are split here, and the split is where claims quietly lose half their value.
Hospital, acute and procedural
Time-based codes and units of service where the documentation has to justify the level as well as the service.
Not sure which page covers your practice?
Tell us your specialty and your top three payers. We will point you at the right page and tell you where we would expect the money to be leaking before you send us anything.
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