Compliance
CY 2026 PFS: What Changed for Behavioral Health Billing
CMS finalized three new CoCM add-on codes. Most billers haven't updated their claim logic for them yet.
Mukesh MakwanaRead →
Practical, no-fluff writing on denials, AI in revenue cycle, compliance and practice growth. Written by Mukesh Makwana.
CMS finalized three new CoCM add-on codes. Most billers haven't updated their claim logic for them yet.
The global maternity package looks simple until a patient switches providers mid-pregnancy or needs a service outside routine prenatal care.
The psychotherapy add-on codes require two separately documented services, and the time split is stricter than most practices realize.
Fresh and frozen embryo transfers use two different CPT codes. Billing 58974 for a frozen cycle is one of the fastest ways to get a claim flagged.
Cardiac cath lab codes bundle aggressively under NCCI. Here's what's genuinely separately payable, and where modifier 59/XS gets misused.
Complete, limited, and follow-up echocardiograms use three different CPT codes. Billing the wrong one is one of the fastest ways to trigger a payer audit.
Prior auth eats 13 hours of staff time per provider per week. Most of it is automatable.
IVF billing has its own code set most general billers never see in volume, and the global period rules trip up even experienced coders.
TC/26 modifier errors on echoes and stress tests are one of the most common, and most preventable, cardiology denial causes.
Prior auth burden is worse in behavioral health than almost anywhere else in medicine. Here's what the latest data actually shows.
Fertility benefit managers run their own authorization and claims rules, separate from the patient's underlying commercial insurance.
Cardiac remote monitoring billing depends on data-transmission windows most practices aren't tracking precisely enough.
We ran the real numbers for a 4-provider practice, including the costs nobody puts in the spreadsheet.
Any vendor can say they're HIPAA compliant. Here are the six documents you should ask to see before signing.
A step-by-step breakdown of how we took one clinic's AR from 45 days to 22 in a single quarter.
Denial prediction isn't magic. Here's exactly what the model looks at, and why it catches things a human scrubber misses.
Most practices budget $25 to rework a denial. The true cost, once you count staff time and write-offs, is closer to $118.
If your clean claim rate is stuck in the low 80s, the cause is almost never one big problem. It's seven small ones compounding.
A free pilot audit shows exactly where your revenue is leaking, with no obligation.