Billing and Credentialing Services: The Complete 2026 Guide for Healthcare Providers
Billing and credentialing services are the combined administrative processes that enable healthcare providers to enroll with insurance payers, verify their professional qualifications, and submit clean claims for accurate reimbursement. These services form the operational foundation of every healthcare practice’s revenue cycle—connecting provider enrollment, payer contracting, charge capture, and claims management into one integrated system. Yet […]
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CPT Code 98975: Complete Billing Guide for Mental Health Providers 2025-2026 Update
What is CPT Code 98975? CPT code 98975 is the billing code for initial setup and patient education in Remote Therapeutic Monitoring (RTM). It covers the onboarding process when providers configure monitoring devices like apps, wearables, or digital therapeutics. The code also includes educating patients on how to use these tools to track therapy adherence, […]
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Prior Authorization Just Changed Everything: What’s Actually Happening in 2026
Prior auth has been broken for years. We all know it. But here’s what’s different: CMS just forced transparency on payers, and the first deadline already hit on January 1st. I’ve been handling medical billing for 15 years. This shift is real, and it’s going to affect every single claim you process. Let me break down what’s […]
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Behavioral Health Revenue Cycle Management: A Clear Path to Faster Payments and Lower Denials
Your day is already packed. Patients need attention. Notes pile up. And somewhere in the background, claims age without explanation. Denials arrive for reasons that make no sense on paper. Staff spend hours chasing authorizations instead of supporting care. This is the reality for most behavioral health practices. The work is clinical. The losses are […]
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What is AI-Driven Underpayment Recovery Systems: Pioneering Fair, Honest, and Compassionate Healthcare Reimbursements
Introduction Every healthcare provider knows the sting of discovering an underpaid claim. It’s not just the money you’re missing; it’s also the time, effort, and attention you put into each patient interaction. You stay late to fix claims, check codes, and follow every rule, but you still get ripped off. It’s exhausting. Those small underpayments […]
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Cracking the Code: How to Overcome the CO 45 Denial Code and Reclaim Your Lost Revenue
Introduction Every denied claim feels like a heart monitor flatlining your cash flow. You’ve delivered outstanding care and coded every detail, and yet—your reimbursement stops cold. One of the most frequent culprits behind that sinking feeling? The CO 45 Denial Code. It’s a phrase you’ve probably seen on an EOB or ERA, but what it […]
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Healthcare Providers’ Complete Guide to the CO-97 Denial Code: What Causes It, How to Fix It, and How to Avoid It
What does the CO-97 Denial Code mean? The CO-97 denial code is a common problem that healthcare providers have when they bill patients. This code shows up when a service or procedure is incorrectly billed separately instead of being bundled with another. This leads to a denial. We at Pro-Medsole RCM know how much CO-97 […]
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The 8-Minute Rule in Therapy Billing: A Simple Guide for Smarter Reimbursements
One of the most significant, yet confusing, Medicare billing concepts in therapy is known as the 8-Minute Rule. It shows you the way outpatient therapists charge via time-based CPT codes under Medicare Part B. This is a rule for all types of therapists, including physical therapists, occupational therapists, and speech-language pathologists who work as suppliers […]
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Modifier 95 in Medical Billing: How to Bill Telehealth Services Correctly in 2025
Introduction With telehealth revolutionizing healthcare in the modern age, proper billing and coding are of utmost importance. Modifier 95 in medical billing is critical for ensuring providers are reimbursed appropriately for telehealth services delivered through audio-video communication. This guide explains what CPT Modifier 95 is, when and how it should be used, how it differs […]
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Understanding POS 11 in Medical Billing: A Complete Guide
Understanding POS 11 in Medical Billing: A Complete Guide Introduction Medical billing is totally about codes that tells what service was provided, who provided it, and where it was performed. One of the most frequently used and mostly misunderstood codes is POS 11 in medical billing. This simple two-digit code has a direct impact on […]
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