Author: One o Seven RCM

UB-04 EDI clearinghouse RCM integration is the process of connecting institutional billing systems with electronic data interchange (EDI) clearinghouses to transmit 837I claim data in payer-compliant formats. This integration enables automated claim scrubbing, real-time error detection, and electronic payer submission before claims reach insurance carriers. Hospitals, skilled nursing facilities (SNFs),…

CPT code 97112 is used for neuromuscular reeducation, and it’s one of the most misunderstood billing codes in therapy. Getting it wrong means denials. Getting it right means clean claims and defensible documentation when auditors come knocking. Here’s the reality: Medicare contractors are actively targeting 97112 in Targeted Probe and…

What You Need to Know Right Now Most practices bill 97530 CPT code without fully understanding what separates it from 97110. That’s where the money leaks start. Payers aren’t confused about the difference. They’re counting on you to be. In 2026, incorrect 97530 billing is costing practices an average of…

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…