Consulting

Oral and maxillofacial surgery billing is different from most dental billing because treatment can cross the boundary between dentistry and medicine. An impacted tooth extraction, facial fracture repair, TMJ surgery, biopsy, orthognathic procedure, or reconstructive surgery may involve dental benefits, medical benefits, or coordination between both.   The clinical procedure alone does not determine where the […]

AI is taking on more repetitive work across healthcare revenue cycle management. Claim status checks, work queue routing, basic edits, denial categorization, and routine follow-up can increasingly be supported by automation. But that raises a more important question for specialty RCM. If AI handles the easy 80 percent, what becomes more valuable in the other […]

Hospitals can provide a service correctly, document it appropriately, and still lose revenue if that service never becomes an accurate charge. This is why charge capture and Charge Description Master management are central to hospital revenue integrity. Charge capture determines whether procedures, supplies, medications, implants, and other billable services reach the patient account. The CDM […]

Hospital revenue leakage rarely begins with one large failure. More often, it develops when smaller errors move from one revenue cycle function to the next without being corrected. An eligibility mismatch can become a registration problem. A missed authorization can turn into a denial. Incomplete documentation can affect coding. A missing charge can reduce claim […]

Spine surgery can generate significant hospital revenue, but it also creates some of the most difficult claims to get right. A single case may involve multiple spinal levels, decompression, fusion, instrumentation, implants, grafts, imaging, assistant surgeons, and different facility and professional billing requirements. That complexity creates financial exposure. A missing procedure, incorrect code combination, authorization […]

Cash flow in an anesthesia group depends on more than case volume. Revenue must move through a billing model where reimbursement is influenced by anesthesia time, base units, payer conversion factors, modifiers, medical direction requirements, documentation, and contract terms. That makes anesthesia revenue cycle management different from many other specialties. A completed case does not […]

Cardiovascular surgery billing brings together some of the most complex clinical, coding, and reimbursement requirements in a hospital. A single case may involve the operating room, anesthesia, perfusion, pharmacy, imaging, intensive care, implants, blood products, and several physicians. Each part of the episode creates information that must reach the final claim accurately. The financial risk […]

A claim is denied, not because the service was unnecessary, the coding was wrong, or prior authorization was missing, but because a patient never returned a form. That’s the frustrating reality behind the PR‑227 denial code. In many practices, these denials pile up quietly in the A/R queue, delaying payment, increasing work for billing staff, […]

ICD-10 coding for acute encephalopathy does not begin with one default code. The correct code depends on how the provider defines the condition, whether the cause is metabolic, toxic, hepatic, hypertensive, or unspecified, and how clearly the diagnosis is supported across the medical record. This distinction can affect severity reporting, MS-DRG assignment, quality data, reimbursement, […]

Accurate Occupational Therapy CPT Codes are essential for reporting therapy services, supporting compliant billing, and receiving appropriate reimbursement. These standardized procedure codes identify the evaluations, therapeutic interventions, and functional training provided during occupational therapy while helping Medicare, Medicaid, and commercial payers determine payment. Looking for a Specialized Occupational Therapy Billing Partner? AnnexMed combines specialty coding […]