We don't guess at codes. We know the specific CPT nuances, Medical Necessity triggers, and payer quirks that affect your bottom line — because we've worked through every one of them.
Book My Free Revenue AuditStruggling with parity law denials or telehealth billing confusion? We handle it.
Parity law denials — insurers illegally applying stricter criteria than medical/surgical benefits
Time-based billing errors — incorrect session length documentation triggering downcoding
Telehealth POS mismatches causing automatic claim rejections
Interactive complexity add-on (90785) being missed — leaving reimbursement unclaimed
E&M complexity, medication management, and psychotherapy add-ons — billed correctly every time.
E&M downcoding — 99215 billed but documentation only supports 99213, triggering audits
Psychotherapy add-ons (90833/90836/90838) missed entirely — significant lost revenue per visit
Parity violations on psychiatric prior auths — more restrictive criteria than medical equivalents
Telehealth prescribing documentation gaps creating billing compliance risks
ABA billing is unlike any other specialty — high auth volume, unit-based coding, and aggressive payer scrutiny.
Wrong provider type billed — BCBA vs. RBT distinction causes mass claim rejections
Auth expirations during high-volume service weeks — one lapsed auth = dozens of unbillable sessions
Unit rounding errors on time-based ABA codes — small errors multiply across hundreds of claims
Parity non-compliance by insurers — visit limits and hour caps that violate federal law
Drowning in Plan of Care renewals and auth expirations? We track every one.
Lapsed Plan of Care authorizations — sessions rendered without valid auth = non-payable claims
GP/GO/GN modifier errors causing claim rejections across every payer
Therapy cap exceptions not documented — KX modifier missing = capped reimbursement
Massage therapy claims denied for insufficient medical necessity documentation
High-dollar procedures require flawless documentation. We make sure the coding matches.
Echo/stress test bundling errors — payers reduce payment when codes are billed incorrectly
Missing prior auths for high-cost imaging — one missed auth on a $3,000 procedure is catastrophic
MIPS reporting failures causing Medicare payment adjustments (-9% penalty risk)
Medical necessity denials on cath procedures — require peer-to-peer to recover
Routine vs. non-routine foot care billing is one of the most denied categories in medicine.
Routine foot care denied without Class Findings — most common denial in podiatry billing
Q-code selection errors on nail care procedures — wrong code = automatic Medicare denial
ABN forms not issued before non-covered services
Custom orthotic DME claims missing HCPCS modifiers
Episode-based payment and OASIS accuracy directly affect your reimbursement. We protect both.
OASIS-E inaccuracies directly lowering clinical grouping scores and PDGM payment rate
RAP submission delays — cash flow gaps when pre-claims aren't submitted in time
Homebound status not sufficiently documented — ADRs and recoupment from Medicare
CMS rule changes not caught in time — billing built on outdated payment models
Beyond the Core Specialties
Contact us — if you have a niche, we will learn it.
Tell Us About Your PracticeStart with a free 15-Minute Revenue Audit. Jennifer will review your specialty, payer mix, and current pain points.
Or call Jennifer: 646-226-2664
