Category: Medical Billing

EDI rejections in medical billing

Guide to Preventing and Resolving EDI Rejections in Medical Billing

Electronic Data Interchange (EDI) rejections are one of the biggest obstacles in the medical revenue cycle process. They prevent claims from reaching the payer’s adjudication system, leading to costly rework, delayed reimbursements, and longer accounts receivable (AR) days. This guide explores the most frequent types of EDI rejections, their root causes, how to interpret EDI […]
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CPT Modifier 99-medical billing

CPT Modifier 99: Comprehensive Guide to Multiple Modifiers in Medical Billing

Key Takeaways CPT Modifier 99 signals that multiple modifiers apply to a single service. Always list Modifier 99 first, followed by others in documentation. Use it only when two or more modifiers are needed to accurately describe the procedure. Check payer rules before applying Modifier 99—some systems allow multiple modifiers without it. Partnering with experts […]
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Denial code CO 45

Denial Code CO 45: Meaning, Causes, and Resolution Strategies

Key Takeaways: CO 45 = “Charge exceeds fee schedule/maximum allowable or contracted rate.” It usually represents a contractual adjustment, not a billable patient balance. Common causes include outdated fee schedules, incorrect coding, or missing modifiers. Prevention requires accurate contract management, claim scrubbing, and staff training. Partnering with Allzone helps healthcare providers streamline denial management and […]
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Postoperative Period Modifiers

Postoperative Period Modifiers in Medical Billing

In medical billing, modifiers play a vital role in ensuring accurate reimbursement, especially during the postoperative period. The postoperative period refers to the specific timeframe following a surgical procedure when related care is typically included in the surgical package and not separately reimbursable. However, certain situations require physicians to perform additional procedures or unrelated services […]
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Modifiers 80, 81, 82, and AS

Modifier 80, 81, 82, AS – Description, Examples, & Usage Guidelines

Medical billing and coding is a critical part of healthcare revenue cycle management (RCM), ensuring providers are reimbursed accurately for their services. Among the many modifiers used in coding, Modifiers 80, 81, 82, and AS are essential in defining the role of assistant surgeons during procedures. Correct usage of these modifiers can prevent claim denials, […]
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medical billing compliance

Top Strategies to Maintain Medical Billing Compliance and Avoid Penalties

In today’s evolving healthcare landscape, medical billing compliance is more than just following rules—it’s about safeguarding your organization from costly fines, legal risks, and reputational damage. Non-compliance in billing and coding can trigger audits, revenue loss, and even exclusion from federal healthcare programs like Medicare and Medicaid. At Allzone Management Services, we help healthcare providers […]
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Modifier 76

Modifier 76 in Medical Billing: Definition, Usage, and Examples

Introduction In medical billing, modifiers play a vital role in explaining the circumstances under which a service or procedure was performed. One such important modifier is Modifier 76, which helps billers and coders indicate when a repeat procedure or service is performed by the same physician or qualified healthcare professional. Accurate use of Modifier 76 […]
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Telehealth Modifier

Telehealth Modifiers: Navigating Billing in the Digital Healthcare Era

Telehealth has rapidly evolved from an emergency solution during the COVID-19 pandemic to a cornerstone of modern healthcare delivery. Patients can now consult providers remotely, access follow-up care, and engage in chronic disease management—all without leaving their homes. As telehealth becomes an essential service, understanding telehealth billing and modifiers is crucial for healthcare providers aiming […]
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Modifiers RT & LT

Modifiers RT & LT in Medical Billing: Best Practices for Accurate Coding

In the complex world of medical billing, accuracy is paramount. One of the most critical components in ensuring precise documentation and reimbursement is the correct use of Modifiers RT and LT. These modifiers are essential in reporting procedures performed on specific anatomical sites and can significantly impact claims processing, denial prevention, and overall revenue cycle […]
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