Research | Medical Billing and RCM Guides

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Practical content for practices that want to collect more of what they bill.

October 22, 2026

How do the JW and JZ modifiers work for drug waste, and what happens if you skip them?

The pair rule, the rounding trap that turns a JW line into a JZ line, what an unprocessable return really costs, and the federal refund program your JW units quietly feed.

Shivam Pujara, Founder

ASC Payment Rules

October 22, 2026

How does the ASC multiple procedure discount work, and which procedure gets full payment?

Medicare pays an ASC 100 percent of the highest national ASC rate in a session and 50 percent of every other discountable procedure. This page shows how the ranking is decided, which procedures escape the cut, and where the money actually leaks.

Shivam Pujara, Founder

Payer-specific billing

October 22, 2026

How to customize medical billing invoices for different insurance providers

How to tailor claims, patient statements and superbills to Medicare, Medicaid, commercial and workers’ comp payers, with the fields and deadlines that change for each one.

Shivam Pujara, Founder

Pharmacy Audits

October 22, 2026

What triggers a PBM audit, and what records do you need to survive one?

What flags a pharmacy for a PBM audit, which records answer each finding, how long to keep them, and how six state audit laws limit recoupment.

Shivam Pujara, Founder

Eligibility verification

October 22, 2026

Where can I find services that provide outsourced eligibility verification?

Six places to buy outsourced eligibility verification, what each costs per check, the in-house math, and why eligibility denials continue after you outsource.

Shivam Pujara, Founder

Plastic Surgery Coverage

October 22, 2026

What documentation turns a panniculectomy into a covered procedure instead of cosmetic?

The five records that make a panniculectomy reconstructive rather than cosmetic, how Medicare prior authorization and dual diagnosis coding work for 15830, and where 15847 fits.

Shivam Pujara, Founder

Pharmacy reimbursement

October 22, 2026

How do DIR fees and PBM clawbacks hit pharmacy revenue after the claim pays?

Retroactive Part D DIR fees ended in 2024, yet pharmacies still lose money after a claim pays. Where it goes in 2026, how to find it on an 835 and what it costs per claim.

Shivam Pujara, Founder

Plastic Surgery Billing

October 22, 2026

How do you handle billing when one operation is part cosmetic, part reconstructive?

How to split one operation between payer and patient: claim the reconstructive codes, quote the cosmetic fee plus the time it adds, and time each portion.

Shivam Pujara, Founder

Billing vendor compliance

October 22, 2026

How to evaluate medical billing companies for transparency and compliance

A due diligence checklist for vetting a billing company’s HIPAA, OIG and fee compliance, plus the raw data that proves it is transparent.

Shivam Pujara, Founder

Molecular Diagnostics Billing

October 22, 2026

What is MolDX, and how do Z-codes affect molecular test reimbursement?

What MolDX is, which states it covers, where the DEX Z-Code goes on each claim type, and why a molecular claim without one denies unprocessable rather than landing on a denial report.

Shivam Pujara, Founder

PRACTICAL GUIDES FOR PRACTICE OWNERS AND ADMINISTRATORS

Latest posts

How do the JW and JZ modifiers work for drug waste, and what happens if you skip them?

How does the ASC multiple procedure discount work, and which procedure gets full payment?

How to customize medical billing invoices for different insurance providers

What triggers a PBM audit, and what records do you need to survive one?

Where can I find services that provide outsourced eligibility verification?

What documentation turns a panniculectomy into a covered procedure instead of cosmetic?

How do DIR fees and PBM clawbacks hit pharmacy revenue after the claim pays?

How do you handle billing when one operation is part cosmetic, part reconstructive?

How to evaluate medical billing companies for transparency and compliance

What is MolDX, and how do Z-codes affect molecular test reimbursement?