Research | Medical Billing and RCM Guides

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

September 28, 2026

How does the No Surprises Act affect out-of-network ED billing and the IDR process?

The Act removes the patient from an out-of-network emergency claim and moves the payment fight to federal arbitration. Deadlines in business days, what filing costs after the June 2026 fee change, how to batch ED claims under the 2026 rule, and the math on whether a claim is worth disputing.

Shivam Pujara, Founder

Cardiac Device Monitoring

September 26, 2026

How do you bill remote cardiac monitoring codes 93296 and 93297 for the same patient?

CPT instructs you not to report 93296 with 93297, whatever the device count. The permitted pairing, the 93297-TC route that replaced G2066, and what a mis-reported 90-day period costs.

Shivam Pujara, Founder

Dermatology Coverage Rules

September 26, 2026

When is a lesion removal cosmetic vs medically necessary, and what documentation proves it?

Medicare publishes seven criteria that make a benign lesion removal medically necessary rather than cosmetic. This page gives all seven verbatim, the note wording that carries them, the ICD-10 pairing that ends the claim, and the math on one mixed visit.

Shivam Pujara, Founder

Echo Component Billing

September 26, 2026

When do you split an echo into professional (26) and technical (TC) components?

Where the patient was when the images were recorded decides whether an echo is global, 26 or TC. The place of service rule, the transesophageal codes that cannot take a modifier, and what MPPR removes from a second technical component.

Shivam Pujara, Founder

ASC Device Billing

September 25, 2026

When can an ASC bill separately for implants and pass-through devices?

Pass-through status, not cost, decides whether an ASC is paid separately for a device. The rule, the quarterly lookup, the FB and FC credit math, and a worked example on a $4,800 procedure rate.

Shivam Pujara, Founder

Ambulance billing

September 25, 2026

What are ambulance origin and destination modifiers, and why do they cause denials?

Ambulance origin and destination modifiers are a two-letter declaration of where a transport started and ended. This page maps every letter, the denial codes modifier errors return, and the coverage rules that deny a technically correct pair.

Shivam Pujara, Founder

Facility and professional billing

September 25, 2026

How does the facility fee split from the surgeon’s professional fee on the same case?

A single surgical case produces a facility claim and as many as three professional claims, priced by different fee schedules. Here is who bills what, on which transaction, and where the split leaks money.

Shivam Pujara, Founder

Drug Buy and Bill

September 25, 2026

How do you buy and bill biologics like Xolair without losing money on the drug?

Buy and bill margin on a biologic is measured in tens of dollars per dose, not hundreds. This page shows the real Medicare arithmetic on a 300 mg Xolair dose, how to find the drugs you are losing money on, and what breaks the model.

Shivam Pujara, Founder

Care management billing

September 25, 2026

How do you bill Chronic Care Management (99490) and Remote Patient Monitoring together?

Medicare lets you bill chronic care management and remote patient monitoring for the same patient in the same month. The hard part is not permission. It is that the two programs run on different clocks and no minute counts twice.

Shivam Pujara, Founder

Medicare E/M Coding

September 25, 2026

When can you bill the G2211 add-on code, and when is it denied?

G2211 pays about 16 dollars a visit and almost every practice leaves some of it on the table. This page sets out exactly which visits qualify, what the modifier 25 rule does after January 1 2025, and the four reasons the line gets denied.

Shivam Pujara, Founder

PRACTICAL GUIDES FOR PRACTICE OWNERS AND ADMINISTRATORS

Latest posts

How does the No Surprises Act affect out-of-network ED billing and the IDR process?

How do you bill remote cardiac monitoring codes 93296 and 93297 for the same patient?

When is a lesion removal cosmetic vs medically necessary, and what documentation proves it?

When do you split an echo into professional (26) and technical (TC) components?

When can an ASC bill separately for implants and pass-through devices?

What are ambulance origin and destination modifiers, and why do they cause denials?

How does the facility fee split from the surgeon’s professional fee on the same case?

How do you buy and bill biologics like Xolair without losing money on the drug?

How do you bill Chronic Care Management (99490) and Remote Patient Monitoring together?

When can you bill the G2211 add-on code, and when is it denied?