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 should a medical billing contract include?

The 12 clauses every medical billing contract needs, with a fee-base worked example, Medicare billing agent rules, KPI targets and exit terms to negotiate.

Shivam Pujara, Founder

Mohs Surgery Coding

October 22, 2026

How do you bill Mohs surgery stages and blocks (17311 and its add-ons)?

17311 pays the first Mohs stage and its first five tissue blocks. Stages after that are 17312 or 17314, and every block past the fifth in any one stage is 17315. This page sets out the unit rules, the repair and biopsy modifiers, and the audit CMS is running on stage units.

Shivam Pujara, Founder

AR aging benchmarks

October 22, 2026

What percentage of AR over 90 days is normal?

Under 15% of AR past 90 days is healthy and under 10% is top performing. Here is how to calculate it, why benchmarks disagree and how to bring it down.

Shivam Pujara, Founder

Primary Care Billing

October 22, 2026

Can you bill an Annual Wellness Visit and a problem-oriented visit on the same day?

Medicare pays a problem-oriented E/M on the same day as an annual wellness visit when the extra work is significant and separately identifiable. What the pair is worth, what the patient owes, and the documentation that survives an audit.

Shivam Pujara, Founder

ENT coverage rules

October 22, 2026

Is balloon sinuplasty covered, and what documentation do payers require?

What Cigna, Aetna, UnitedHealthcare and Medicare require before they pay for balloon sinus dilation, the CPT codes and 2026 rates, and the documentation gaps behind most denials.

Shivam Pujara, Founder

Allergy immunotherapy coding

October 22, 2026

What is the difference between 95165 antigen preparation and 95115/95117 injection billing?

The antigen preparation code and the injection codes pay for different work, on different dates, in different units. How each one is counted, capped and denied.

Shivam Pujara, Founder

Infusion and Chemotherapy Coding

October 22, 2026

What is the correct hierarchy for chemo administration codes when infusions run concurrently?

Chemotherapy is primary to therapeutic and prophylactic services, which are primary to hydration, and infusions are primary to pushes. The rule most teams get wrong is that 96368 is still reportable when a non-chemo drug runs alongside chemotherapy.

Shivam Pujara, Founder

Cardiology Billing

October 22, 2026

What falls inside the global period after a cardiac catheterization?

Diagnostic cardiac catheterization and PCI codes carry a 000 global indicator, which means the payment bundle covers the date of service and nothing after it. This page sets out what is actually included, what stays separately payable, and which modifier belongs on a same-day E/M.

Shivam Pujara, Founder

Medicare hearing coverage

October 22, 2026

What hearing services does Medicare actually cover, and which are patient responsibility?

A billing-side breakdown of every hearing service Medicare Part B pays for, every one it excludes by statute, and the implanted devices it covers anyway. With 2026 cost sharing, the codes and the modifiers.

Shivam Pujara, Founder

Emergency Department Billing

October 22, 2026

Can you bill critical care 99291 and an ED E/M on the same visit?

When a patient in the emergency department needs critical care, 99291 normally replaces the ED visit level. This page sets out the one sequence that keeps both services payable, which line carries modifier 25, and why the facility claim answers to a different rule.

Shivam Pujara, Founder

PRACTICAL GUIDES FOR PRACTICE OWNERS AND ADMINISTRATORS

Latest posts

What should a medical billing contract include?

How do you bill Mohs surgery stages and blocks (17311 and its add-ons)?

What percentage of AR over 90 days is normal?

Can you bill an Annual Wellness Visit and a problem-oriented visit on the same day?

Is balloon sinuplasty covered, and what documentation do payers require?

What is the difference between 95165 antigen preparation and 95115/95117 injection billing?

What is the correct hierarchy for chemo administration codes when infusions run concurrently?

What falls inside the global period after a cardiac catheterization?

What hearing services does Medicare actually cover, and which are patient responsibility?

Can you bill critical care 99291 and an ED E/M on the same visit?