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 you bill the ABA assessment codes 97151 to 97158, and who has to render each one?

A code by code guide to the ABA billing codes 97151 to 97158, covering who must render each one, how the 15 minute unit math works, when 97153 and 97155 can share clock time, and what the January 2027 code changes break.

Shivam Pujara, Founder

Neonatal Intensive Care Coding

October 22, 2026

How does NICU billing change when the baby is no longer critically ill?

The step down out of neonatal critical care is decided by present body weight, not by code family, and 99477 is not available to fall back on. This page gives the decision tree, the per-day amounts and the rules that make these claims deny.

Shivam Pujara, Founder

Colorectal Screening Billing

October 22, 2026

How do you bill G0105 and G0121 for Medicare screening colonoscopies?

G0105 covers high-risk patients and G0121 everyone else, and Medicare counts both clocks in whole months rather than years. This page sets out the two intervals, what the patient owes once a polyp comes out, when modifier KX is required, and how the ASC and anesthesia claims have to match.

Shivam Pujara, Founder

Choosing a billing company

October 22, 2026

How to choose a medical billing company for a small clinic

A step-by-step guide for small clinics on choosing a medical billing company, with real pricing ranges, a worked cost example and the contract questions most practices miss.

Shivam Pujara, Founder

ESRD Monthly Coding

October 22, 2026

How do the monthly capitation codes 90951 to 90970 change by patient age and visit count?

Twenty codes, two variables. The in-center codes carry visit tiers and the home codes do not, and the age that decides the row is the patient’s age at the end of the month rather than at any date of service.

Shivam Pujara, Founder

ABA Therapy Billing

October 22, 2026

How is RBT time billed when a BCBA is supervising under 97155?

When a BCBA joins a session to direct the technician, 97155 and 97153 describe two different services, so both are usually reportable. The exceptions, the unit math and the payer split are laid out here.

Shivam Pujara, Founder

RCM pricing

October 22, 2026

What is the cost range for outsourced revenue cycle management services?

What outsourced revenue cycle management costs, how RCM pricing models compare, which fees sit outside the percentage, and a worked example for a 3-provider practice.

Shivam Pujara, Founder

Gastroenterology Coding

October 22, 2026

When does a screening colonoscopy become diagnostic, and when do you use modifier PT?

The conversion rule, where modifier PT goes, what the patient owes by year band, and the month counts that decide whether a screening colonoscopy pays at all.

Shivam Pujara, Founder

Audiology and Vestibular Coding

October 22, 2026

How do you bill tinnitus and vestibular testing without a denial?

The 92540 bundling rule, the 92625 and 92557 same day question, the diagnoses that support medical necessity, and a seven step scrub that stops the denials appeals cannot fix.

Shivam Pujara, Founder

FQHC Payment Methodology

October 22, 2026

How do FQHC wrap-around payments from Medicaid actually get calculated?

Medicaid owes a health center the difference between its PPS encounter rate and what the managed care plan paid. This page sets out the arithmetic, the four-month payment floor, how eight states actually run it, and which encounters qualify.

Shivam Pujara, Founder

PRACTICAL GUIDES FOR PRACTICE OWNERS AND ADMINISTRATORS

Latest posts

How do you bill the ABA assessment codes 97151 to 97158, and who has to render each one?

How does NICU billing change when the baby is no longer critically ill?

How do you bill G0105 and G0121 for Medicare screening colonoscopies?

How to choose a medical billing company for a small clinic

How do the monthly capitation codes 90951 to 90970 change by patient age and visit count?

How is RBT time billed when a BCBA is supervising under 97155?

What is the cost range for outsourced revenue cycle management services?

When does a screening colonoscopy become diagnostic, and when do you use modifier PT?

How do you bill tinnitus and vestibular testing without a denial?

How do FQHC wrap-around payments from Medicaid actually get calculated?