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

What is a good claim denial rate?

What counts as a good claim denial rate, how to calculate it the HFMA way, and what published benchmarks and our billing data show.

Shivam Pujara, Founder

Hospital E/M Coding

October 22, 2026

When do you bill 99234 to 99236 for same-day admit and discharge?

The 8-hour rule decides this code family, and the CMS text that carries it is not where most guidance says it is. What to bill at every length of stay, what the note has to say, and what the codes pay in 2026.

Shivam Pujara, Founder

Therapy billing rules

October 22, 2026

How does the 8-minute rule work in physical therapy billing?

How Medicare’s 8-minute rule turns therapy minutes into billable units, with the full chart, a worked example and the payer and modifier rules around it.

Shivam Pujara, Founder

Allergy testing billing

October 22, 2026

How many units of 95004 can you bill for a skin test panel?

One unit of 95004 is one antigen, and Medicare stops paying at 80 units on a single date of service. This page gives the ceiling, the payer caps that sit under it, and the math on what a panel actually pays.

Shivam Pujara, Founder

Ophthalmology Coding

October 22, 2026

How does cataract surgery co-management work with modifiers 54 and 55?

Both providers bill the same cataract code on the same date, split 80/20, with the postoperative share prorated by days. Here is the claim build, the 2026 math, the 2025 transfer of care change and what an audit actually looks at.

Shivam Pujara, Founder

Hospital Status Determination

October 22, 2026

How does the two-midnight rule decide observation vs inpatient status?

The rule is about what the admitting practitioner expected, not how long the patient stayed. This page separates the benchmark from the presumption, shows which hours count, and covers how to fix a status that was already wrong.

Shivam Pujara, Founder

Surgical Billing

October 22, 2026

When do you use modifier 62 for co-surgeons, and how is payment split?

What modifier 62 actually requires, how to check the CO-SURG indicator before the case, and what each co-surgeon is paid, with the claim math worked on a real spine code.

Shivam Pujara, Founder

Surgical Modifiers

October 22, 2026

When does an assistant at surgery get paid (modifiers 80, 82, AS)?

Three things decide whether an assistant at surgery gets paid: who assisted, what the code’s assistant indicator says, and whether the operative note describes the assistant’s role. Here is each one, with the dollar math.

Shivam Pujara, Founder

Therapy Certification

October 22, 2026

Expired plans of care are a revenue struggle, not a paperwork issue

An expired therapy plan of care stops the claim, not just the chart. The Medicare certification deadlines, how long held charges sit before release, and the tracking setup that gets them out the door.

Shivam Pujara, Founder

Eye Care Coding

October 22, 2026

When do you use eye codes 92002 to 92014 instead of E/M codes?

Eye codes are graded on the examination, office E/M codes on decision making since 2021. The 2026 fee schedule makes the payment advantage flip by level rather than by family.

Shivam Pujara, Founder

PRACTICAL GUIDES FOR PRACTICE OWNERS AND ADMINISTRATORS

Latest posts

What is a good claim denial rate?

When do you bill 99234 to 99236 for same-day admit and discharge?

How does the 8-minute rule work in physical therapy billing?

How many units of 95004 can you bill for a skin test panel?

How does cataract surgery co-management work with modifiers 54 and 55?

How does the two-midnight rule decide observation vs inpatient status?

When do you use modifier 62 for co-surgeons, and how is payment split?

When does an assistant at surgery get paid (modifiers 80, 82, AS)?

Expired plans of care are a revenue struggle, not a paperwork issue

When do you use eye codes 92002 to 92014 instead of E/M codes?