Medical billing FAQ

Most billing companies charge a percentage of what they collect for you; some charge per claim or a flat monthly fee. Beeline charges a small percentage of collections, agreed up front.

No. Beeline works without lock-in contracts: you stay because of the results.

Yes. Beeline is based in Missouri and works for healthcare providers across the United States.

No. A consultation needs nothing but a conversation, and the free billing audit works from summary reports with no patient names. Please don’t send patient information through this website.

Book a free consultation from any page. Tell us about your practice and what is slipping, and we’ll walk you through where your billing stands and what we would handle.

It is confirming, before a visit, that the patient’s insurance is active on the date of service and what the plan covers for that service: the copay, deductible, coinsurance, visit limits, network status, and any referral or authorization it requires.

Coverage changes between visits. Patients change jobs and plans, deductibles start again when a plan year renews, and visit limits get used up. A check before each visit finds those changes before the claim is sent.

The visit is flagged to your team before the patient arrives, with what was found: inactive coverage, a different payer, or a plan that needs a referral or authorization. Your team then decides with the patient how to go ahead.

A coder reads the provider’s documentation for a visit and assigns the codes a claim is built from: CPT or HCPCS codes for the services, ICD-10-CM codes for the diagnoses, and any modifiers. The codes have to match what the record supports and what the payer’s rules allow.

Coding turns the visit into codes. Billing turns those codes into a claim, sends it to the payer and follows it until it is paid. Beeline does both, so a coding question found during billing goes straight back to the coder.

CPT codes change each January and ICD-10-CM codes each October, and payers change their own policies through the year. Codes are checked against the current code sets and payer rules before each claim goes out.

A claim with everything the payer needs to process it the first time: correct patient and insurance details, valid codes and modifiers, the right place of service and provider information, and nothing that fails the payer’s edits.

The CMS-1500 (sent electronically as the 837P) is the professional claim that physicians and other practitioners use. The UB-04 (the 837I) is the institutional claim that facilities such as hospitals and home health agencies use. Which one applies depends on who provided the service, not on the payer.

It depends on the payer. Medicare’s limit is 12 months from the date of service. Commercial and Medicaid plans set their own limits in their contracts and rules, and some are much shorter, so each claim is worked to its payer’s deadline.

Yes. Entering the charges is where a claim starts, so it is part of this service: charges are matched to your schedule, entered with the patient’s details, and checked before the claim is built.

A rejected claim never reached processing: it failed the clearinghouse or payer checks, usually for missing or invalid data, and it is corrected and resubmitted. A denied claim was processed and the payer refused to pay it, so it needs a correction, a reconsideration or an appeal.

It depends on the payer. For Medicare Part A and Part B, the first appeal (a redetermination) must be filed within 120 days of receiving the initial determination. Commercial payers set their own limits in their provider contracts and manuals, so each appeal is worked to that payer’s deadline.

Yes. Each month you see denials broken down by reason and by payer, the appeals still open, and what was recovered, so the causes can be fixed where they start.

It is working the insurance claims that have been sent but not paid: checking each one’s status with the payer, finding out why it is unpaid, fixing the problem, and following up until the claim is paid or closed.

Unpaid claims grouped by how long they have been open, usually 0–30, 31–60, 61–90 and over 90 days. The buckets show where money is stuck and which claims are nearest their payer’s deadlines.

Days in A/R is the average number of days it takes to collect what you bill. It is your total accounts receivable divided by your average daily charges.

It is recording each payment from a payer or patient against the claim it pays, with the contractual adjustments and the patient’s share, so every account shows what is paid and what is still owed.

A claim adjustment reason code (CARC) says why a payment differs from the amount billed, and a group code says who is responsible for the difference: CO for a contractual obligation the patient can’t be billed for, PR for the patient’s share, such as a deductible or copay, OA for other adjustments and PI for reductions the payer made. CO-45, for example, means the charge was more than the payer allows.

Each payment is compared with the amount your contract or fee schedule allows for that code. When a payer pays less, the line is flagged and followed up with the payer instead of being adjusted off.

Yes. ERAs are posted electronically and paper or PDF EOBs by hand, so every payment ends up on its claim.

It depends on the payer. Each sets its own process and timeline, and some take several months from a complete application to an effective date. A complete, consistent application avoids the delays that missing information causes.

The provider’s licences, DEA registration if they have one, board certification, malpractice insurance, NPI and work history, the practice’s tax ID and W-9, and access to the provider’s CAQH profile if they have one.

Yes. Re-credentialing dates, licence and insurance expiries and CAQH re-attestations are tracked and worked before they come due.

Yes. A new provider is credentialed and enrolled with the payers your practice bills and linked to your group, so their claims can be paid.

Whether what was billed matches what was documented and what the payer allows: the codes and visit levels, the modifiers, the diagnoses that support each service, and the payer’s and CMS’s rules for each.

The OIG’s compliance guidance for physician practices counts regular auditing and monitoring as a basic part of a compliance program. How often depends on your size, your specialties and past findings, and areas with problems are checked again sooner.

It is measuring how charges become payments in your practice, and where that slows down or leaks: which payers deny or underpay, which claims age, and how much of what you are owed you collect.

A few cover most of it. Days in A/R: how long it takes, on average, to collect what you bill. Net collection rate: what you collected out of what you could have collected, after contractual adjustments. Denial rate: the share of claims denied. Clean claim rate: the share of claims accepted on the first submission.

Yes. Reports are customised to what you need to see, by payer, provider, location or service.

Four: 97810 for the first 15 minutes of one-on-one contact without electrical stimulation, and 97811 for each further 15 minutes with re-insertion of needles; 97813 and 97814 are the same with electrical stimulation. Only one of the initial codes, 97810 or 97813, is billed a day.

Only for chronic low back pain, since January 2020: pain lasting 12 weeks or longer with no identifiable systemic cause, not related to surgery or pregnancy. Medicare covers up to 12 visits in 90 days, 8 more for patients who are improving, and no more than 20 a year.

No. Acupuncturists aren’t Medicare providers. A physician, physician assistant, nurse practitioner or clinical nurse specialist bills covered acupuncture, and an acupuncturist who meets Medicare’s education and licensing requirements may give it under their supervision.

Both are psychiatric diagnostic evaluations. 90791 is the evaluation without medical services, used by psychologists, counselors and social workers as well as prescribers. 90792 adds medical services, such as a medication review or a physical exam, and is billed only by physicians and other practitioners who can provide them.

By the time spent in psychotherapy with the patient or a family member: 90832 for 16 to 37 minutes, 90834 for 38 to 52 minutes and 90837 for 53 minutes or more. A session under 16 minutes isn’t billed as psychotherapy.

Yes, with most payers, using the same psychotherapy codes with the place-of-service code the payer wants (02, or 10 when the patient is at home) and its telehealth modifier. Medicare covers mental health visits by telehealth in the patient’s home, and each Medicaid program and commercial plan sets its own rules.

Mostly. Behavioral health is the wider term, taking in substance use treatment as well as mental health, and both are billed with the same psychiatric codes. Medicaid programs often add their own HCPCS codes, the H codes, for substance use and community services.

AT tells Medicare that a spinal manipulation was active, corrective treatment of a subluxation. Without it Medicare treats the manipulation as maintenance care, which it doesn’t cover, and denies the claim.

Only manual manipulation of the spine to correct a subluxation, billed with 98940, 98941 or 98942. Exams, X-rays, therapies, supplies and extraspinal manipulation aren’t covered when a chiropractor provides them.

When a service is expected to be denied as not reasonable and necessary, such as maintenance care. GA means the patient signed an Advance Beneficiary Notice, so they can be billed if Medicare denies it; GZ means there is no ABN, and the patient generally can’t be billed.

CDT (Current Dental Terminology) is the code set the American Dental Association publishes for dental procedures, each a D followed by four digits, such as D1110 for an adult cleaning. Dental plans require CDT codes on claims, and the set is updated every January 1.

Yes, for procedures a medical plan covers, such as some oral surgery, treatment after an accident or an oral appliance for sleep apnea. They are billed on a medical claim with CPT or HCPCS procedure codes and ICD-10 diagnosis codes, not CDT codes.

It is when a plan pays a procedure at the rate for a less costly alternative, often called an alternate benefit: paying a tooth-colored filling on a back tooth at the rate for an amalgam filling, for example. The patient owes the difference, so it is worth knowing before treatment.

They say how a DME item was supplied: NU is new equipment bought by the patient, UE is used equipment bought, and RR is a rental. Medicare requires one of them on claim lines for equipment that can be bought or rented.

Equipment Medicare pays for as a monthly rental for up to 13 continuous months, after which the patient owns it, such as hospital beds and many wheelchairs. Its claims carry the RR modifier with KH for the first month, KI for the second and third, and KJ for months four to thirteen.

It tells the payer that the coverage criteria in the item’s policy are met and documented in the record. Medicare requires it on items whose policies call for it, and denies those claims without it.

No. For dates of service from January 1, 2023, Medicare no longer requires CMNs or DME information forms. The information they held, such as an oxygen patient’s test results, still has to be in the medical record, and other payers set their own documentation rules.

Basic life support transports are billed with A0428 for non-emergency trips and A0429 for emergencies. Advanced life support needs an ALS assessment or at least one ALS intervention, and is billed with A0426 (non-emergency) or A0427 (emergency) at level 1, or A0433 at level 2. The level billed must match the care documented.

Two letters on each ambulance claim line: the first says where the trip started and the second where it ended. R is a residence, H a hospital, S the scene of an accident or acute event, N a skilled nursing facility and P a physician’s office, so a trip from home to the hospital is RH.

Separately from the level of service, per loaded mile: only the miles with the patient on board count. Medicare pays mileage to the nearest appropriate facility and wants it to a tenth of a mile on trips under 100 miles. Ground mileage is billed with A0425.

Yes, when the provider treats a significant problem during a preventive visit. The preventive visit is billed with its age-based code and the problem with an office visit code and modifier 25, and the note must show the work for each. The patient may owe cost sharing for the problem visit.

Both bill vaccine administration. 90460 is for patients through age 18 when the physician or other qualified professional counsels the patient or family about the vaccine; it is billed per vaccine, with 90461 for each further component. 90471–90474 are for other patients, or when there is no such counseling.

No. The annual wellness visit (G0438 the first time, G0439 after that) is a health risk assessment and a personal prevention plan, not a head-to-toe exam. Medicare doesn’t cover routine physicals; its one-time Welcome to Medicare visit (G0402), in the first 12 months of Part B, is a preventive visit too.

The Patient-Driven Groupings Model is how Medicare has paid home health since January 2020. Each 30-day period of care is placed in a payment group by its admission source and timing, the primary diagnosis, the patient’s functional level from OASIS and their comorbidities, and the group sets the payment.

The notice an agency sends Medicare at the start of care to establish the admission. It is due within five calendar days of the start of care, and for each day it is late Medicare reduces the payment for that period.

The visit, in person or by telehealth, in which a physician or allowed practitioner saw the patient for the main reason they need home health. It must happen from 90 days before to 30 days after the start of care, and the certifying practitioner documents it.

A low-utilization payment adjustment. When a 30-day period has fewer visits than its payment group’s threshold, which is between two and six visits, Medicare pays per visit instead of the period’s full payment.

Since 2021, office and outpatient visits (99202–99215) are leveled by either the medical decision making documented or the total time the practitioner spent on the patient’s care that day. History and exam are documented as the visit needs them, but no longer set the level.

Chronic care management (99490) pays for at least 20 minutes a month of clinical staff time on the care plan of a patient with two or more chronic conditions expected to last at least 12 months. The patient’s consent has to be recorded first, and only one practitioner can bill it for a patient in a month.

Transitional care management (99495, 99496) covers the 30 days after a patient leaves a hospital or facility. It needs contact with the patient within two business days of discharge and a face-to-face visit within 14 days for 99495, or within 7 days for 99496, which also needs high-complexity decision making.

On a visit billed on the same day as a procedure or a preventive service, when the visit dealt with a significant, separately identifiable problem. The note has to show that work apart from the procedure or the preventive visit, or the payer pays only one of them.

CLIA, the Clinical Laboratory Improvement Amendments, requires every lab that tests human specimens for diagnosis or treatment to hold a CLIA certificate. Medicare claims for lab tests must include the lab’s CLIA number, and the type of certificate has to cover the tests billed: a lab with a certificate of waiver can bill only waived tests, with the QW modifier.

An ABN is a form a Medicare patient signs before a test that Medicare may not cover for their diagnosis. With a signed ABN, the claim is sent with modifier GA and, if Medicare denies it, the patient can be billed. Without one, the lab generally can’t bill the patient for a test Medicare denied as not medically necessary.

A presumptive test shows whether a drug class may be present, usually by immunoassay, and is billed with 80305, 80306 or 80307 depending on the method. A definitive test identifies the specific drugs, usually by mass spectrometry, and is billed by the number of drug classes tested: G0480–G0483 for Medicare, 80320–80377 for many other payers.

It is how Medicare turns time into units for timed therapy codes. Add up the minutes of all timed services in the session, then bill one unit for 8 to 22 minutes, two for 23 to 37, three for 38 to 52, and so on in 15-minute steps. A service under 8 minutes can still count toward the total.

It tells Medicare that therapy above its yearly threshold is still medically necessary, and that the record shows it. Physical therapy and speech therapy share one threshold, occupational therapy has its own, and CMS sets the amount each year.

Yes for Medicare, and many other payers ask for it too: GP marks a service given under a physical therapy plan of care. Occupational therapy uses GO and speech-language pathology GN.

At least once every 10 treatment days, written by the therapist. It is separate from recertifying the plan of care, which is needed at least every 90 days.

From January 1, 2027, ten timed codes replace 92507 for individual treatment, one pair per clinical area: fluency (92654, 92655), speech sound production (92656, 92657), language (92658, 92659), speech sound and language combined (92660, 92661), and voice, upper airway and resonance (92662, 92663). Each pair is a base code for the first 30 minutes and an add-on for each further 15. 92507 stays in use through December 31, 2026.

Only to timed codes. Through 2026, 92507, 92526 and the evaluations are untimed and billed once per session, while timed codes such as cognitive function intervention (97129 for the first 15 minutes, 97130 for each further 15) follow Medicare’s rules for time. From 2027 the codes that replace 92507 are timed too, so the minutes documented for each clinical area decide what is billed.

92521 for fluency, 92522 for speech sound production, 92523 for speech sound production with language, 92524 for voice and resonance, and 92610 for swallowing. 92523 includes what 92522 covers, so the two aren’t billed together.

GN marks a service given under a speech-language pathology plan of care. Medicare requires it on every SLP service, and many other payers ask for it too.

The time around an operation whose routine care is paid as part of the surgery: 0 or 10 days for minor procedures and 90 days for major ones. For a major operation it includes the visit the day before or the day of surgery and the routine follow-up visits.

Both mark a visit on the same day as a procedure as paid on its own. Modifier 57 is for the visit at which the decision for a major (90-day) operation was made, the day before or the day of surgery. Modifier 25 is for a significant, separate problem treated on the same day as a minor procedure.

During a procedure’s global period. 78 is for an unplanned return to the operating room for a related procedure, such as treating a complication; 79 is for a procedure unrelated to the first surgery. A 78 procedure doesn’t start a new global period; a 79 procedure does.

By the deepest level of tissue removed and the total area. 11042 is subcutaneous tissue, 11043 muscle or fascia and 11044 bone, each for the first 20 sq cm, with add-on codes for each further 20 sq cm. Selective removal of dead tissue from the wound surface uses 97597 and 97598.

In two parts: the product, with its own HCPCS Q code billed by the square centimeter used, and the application, with a CPT code from 15271 to 15278 chosen by the wound’s size and body area. Coverage depends on the payer’s policy for the type of wound.

Medicare covers it for listed conditions only. A diabetic wound of the lower leg or foot must be Wagner grade III or higher and must not have healed after an adequate course of standard wound care, of at least 30 days. A hospital outpatient department bills it with G0277 per 30 minutes, and the physician’s attendance with 99183.