Author: One o Seven RCM

An entity code is a role identifier in your electronic claim file. It’s a two-character qualifier, defined by ANSI X12 standards, that tells the payer what function each party serves on a specific transaction. Your NPI says who you are. The entity code says what you’re doing. Same doctor, same…

Getting paid in healthcare starts with one decision: which clearinghouse handles your claims. Pick the wrong one and you’re stuck with rejections, delays, and hours of rework. Pick the right one and claims flow smoothly from your system to the payer and back as payment. This guide breaks down the…

If you’ve noticed more payer audits, tighter Medicare oversight, and rising denial volumes in 2025, you’re not imagining things. The difference between inpatient and outpatient coding has quietly become one of the most decisive factors in financial stability and compliance success for hospitals and medical groups across the United States.…

It seems straightforward to run an ambulatory surgery center from the outside: patients come in, procedures go smoothly, and everyone goes home the same day. However, underlying that smooth workflow is a money-making machine that never stops. One missed authorization, a forgotten modifier, or an ambiguous operative note can slow…

In 2025, time-based coding is a critical component of appropriate reimbursement and compliance in medical billing. If you are not capturing the data as such today, this analysis reflects an opportunity: Healthcare professionals across the US are moving toward clock-in/clock-out style documentation to prepare for updated CPT 2025 guidelines and…

In the field of medical billing, the UB-04 claim form is one of the most essential tools for a healthcare facility. Speaking of which, this form is essential because it ensures that hospitals, nursing facilities, rehabilitation centers, and other health providers may file claims for reimbursement with great accuracy. The…

Introduction In the medical billing world, every claim submitted represents a story—the story of accuracy, speed and financial control. This “clean claim rate,” as it’s known in medical billing, is a measure of how many of those stories ultimately win on the first try. It is one of the most…

In the complex world of medical billing, net collection rate is one of the most critical metrics that determines the financial health of a healthcare practice. For any medical provider, managing claims and reimbursements efficiently is not just about getting paid, it’s about knowing how effectively payments are collected in…

Introduction Medical billing is a field that demands precision, knowledge of payer rules, and compliance with regulatory policies. Among the terms that healthcare providers and billing professionals encounter, local coverage determination plays a central role in how claims are processed by Medicare. For practices working with patients covered under federal…