Billing by specialty
Cardiology denials are not dermatology denials. Each of these covers the codes, the denial patterns and the payer behavior specific to that specialty.
Anesthesia
Anesthesia is the one specialty that does not bill in CPT units the way everyone else does. Payment is base units plus time units plus modifiers, multiplied by a conversion factor, which means an error in any one input changes the payment on every claim.
Behavioral health
Behavioral health billing is time-based, and the time has to be in the note. It is also the specialty where payers most often carve benefits out to a separate manager, so a claim sent to the medical payer is not late, it is at the wrong address.
Cardiology
Cardiology billing lives on the boundary between diagnostic and interventional work, and payers police that boundary hard. A single cath lab visit can generate a professional component, a technical component and a facility charge, and getting the split wrong is not a coding error the scrubber will catch.
Dermatology
Dermatology bills high volumes of small procedures, often several in one visit, and the money is lost in lesion counts, sizes and whether the visit was cosmetic. It is a specialty where a single documentation habit changes the revenue on hundreds of claims.
Family medicine
Family medicine bills a high volume of low value claims, which means small systematic errors compound faster here than anywhere else. A practice consistently coding one level too low loses more over a year than most practices lose to denials.
Gastroenterology
Gastroenterology billing turns on one distinction more than any other: was this colonoscopy screening or diagnostic? The answer changes the code, the patient's cost share, and whether your front desk has an angry phone call to handle.
OB/GYN
Obstetric care is billed as a global package covering months of care in a single code, which means a patient who transfers in or out mid-pregnancy breaks the model. Most OB billing problems are really global package problems.
Orthopedics
Orthopedic billing is global periods and modifiers. A surgery bought a package of postoperative care, and everything that happens inside that window either belongs to the package or has to be shown not to. Most orthopedic revenue leakage happens in that argument.
Pediatrics
Pediatric billing is well-child visits, vaccines and Medicaid, in roughly that order. Immunization administration coding is where most practices lose money, because the counselling codes are easy to underuse and nothing flags it.
Physical therapy
Physical therapy is billed in timed units, which makes it one of the most audit-exposed specialties there is. The unit count has to follow from documented treatment minutes, and if it does not, the claim is indefensible however good the care was.
Radiology
Radiology billing depends on information generated by someone else. The ordering provider writes the indication, and if that indication does not meet the payer's criteria, the denial arrives at your practice rather than theirs.
Urgent care
Urgent care sees patients once, usually without a relationship and often without correct insurance information. Most of what goes wrong in urgent care billing is decided at the front desk in the ninety seconds before the patient sits down.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.