Callidus Billing, Inc.

11/03/2025

Most clinics think their Medicare Advantage lineup is stable for 2026. It’s not.

Major carriers are quietly redrawing coverage maps—exiting some counties, trimming networks, and reshaping plan IDs without fanfare. The result? January denials for “plan not active” and “member not found,” right when clinics can least afford cash-flow shocks.

We break down what’s changing beneath the surface—and how to spot it before the denials hit.

Read the full post: *Medicare Advantage 2026: The Quiet Shake-Up That Could Upend Your Revenue*
👉 https://callidusbilling.com/blog/

10/31/2025

🎃 Billing Tip Friday: Don’t Let Denials Haunt You

Before you hit “submit” on claims, run this pre-claim checklist:

✅ Eligibility/Auth: Confirm patient coverage and authorization for procedures.
✅ CPT↔DX Match: Make sure diagnosis codes justify the procedure per payer rules.
✅ Modifiers/Units: Double-check edits against LCD/NCD/CCI to avoid instant rejections.

A few minutes of verification now can save hours of rework later.
Keep those denials from creeping back from the grave. 👻

10/29/2025

Short-Term Coverage, Zero Headaches

Need billing help now—not “in 90 days”? Callidus plugs in fast to keep cash flow moving while your team focuses on patients.

Here’s what you get from Day 1:
✅ Fast onboarding with minimal disruption
✅ Immediate relief on claim submission & A/R follow-up
✅ Cleaner claims → quicker payments
✅ Reliable coverage during staff leave or turnover
✅ No setup fees. No contracts. Just results.

We make it easy to keep your billing running smoothly while you stay focused on care.

Message us to start a 2-week pilot and see the difference for yourself.

10/27/2025

CMS is recalling furloughed staff to support Medicare & ACA Open Enrollment — despite the ongoing government shutdown.

Why this matters:
• Open Enrollment is one of the busiest times of the year for Medicare.
• With staffing disruptions, there may still be delays, backlogs, and slower response times in the coming weeks.
• This move aims to stabilize operations and reduce the impact on beneficiaries and providers.

Full article:
(Reuters) https://www.reuters.com/business/healthcare-pharmaceuticals/us-medicare-agency-recalls-furloughed-staff-support-open-enrollment-despite-2025-10-23/?

10/10/2025

As we recognize World Mental Health Day, it’s a good time to highlight an often-overlooked part of supporting patients, getting the billing right for psychiatry and behavioral health.

Psychiatry billing isn’t like other specialties. The rules, modifiers, and time-based codes can make or break reimbursement.

Here are a few reminders for mental-health practices:
- Use the correct time-based CPT codes — 90791 (evaluation), 90832/90834/90837 (therapy 30/45/60 min). Document start and end times clearly.
- Telehealth claims still need the 95 modifier — even if both patient and provider are in the same state.
- Protect patient privacy in claim notes — keep documentation clinically sufficient but free of sensitive details.
- Link medical necessity codes carefully — pair psychiatric diagnosis codes (F-codes) with specific therapy CPTs to reduce denials.

Precision in psychiatry billing means fewer claim rejections and more time for patients who need care.

📘 In recognition of World Mental Health Day, let’s continue supporting both patients and the providers who serve them.

10/08/2025

Outsourcing Medical Billing: From Cost Savings to Survival Strategy

The U.S. medical billing outsourcing market is projected to nearly double by 2030 — from $6.3 billion to over $12 billion.
That growth reflects a reality most practices already feel: billing has become too complex to manage alone.

Here’s what’s driving the shift:
🧠 Complexity overload — new CPT codes, evolving payer audits, and prior authorizations keep tightening margins.
💸 Cost efficiency — outsourcing reduces overhead while improving cash flow stability.
⚙️ Tech leverage — AI-driven automation is reshaping claim accuracy and denial prevention.
⏰ Talent shortage — seasoned billers are retiring faster than replacements are trained.

But outsourcing isn’t one-size-fits-all. Practices need partners who understand compliance, transparency, and patient trust — not just data entry.

At Callidus Billing, we’ve built our services around that exact balance:
✔️ Experienced billers trained on specialty-specific workflows
✔️ Automation that boosts accuracy without losing the human touch
✔️ Clear reporting and communication every step of the way

📊 Bottom line:
Outsourcing isn’t just a financial decision anymore — it’s a survival strategy.
The right partner doesn’t just process claims. They protect your revenue.

🔗 https://callidusbilling.com/contact

10/06/2025

Blockchain Is Quietly Rewriting the Rules of Medical Billing

The next phase of medical billing may rely less on intermediaries and more on trustless automation.

Blockchain technology is being tested as a framework for transparent, tamper-proof claims processing. Every step in the billing cycle, from claim submission to payer review and reimbursement can be recorded on a shared, encrypted ledger. This allows both parties to see the same data in real time, eliminating discrepancies and lost claims.

Smart contracts take it further: once a claim meets pre-set conditions, payment can be automatically triggered, reducing administrative lag and human error.
Early pilot programs show reconciliation times dropping by more than 70%, with improved auditability and fraud prevention.

It’s not mainstream yet, but adoption is gaining traction across research and healthcare technology circles.

🔗 Read more from the MDPI Journal on how blockchain and smart contracts are reshaping healthcare operations: https://www.mdpi.com/2078-2489/16/10/853?utm_source

10/03/2025

Billing Tip Friday

When billing for preventive services like mammograms:

✅ Use the correct ICD-10 screening codes (e.g., Z12.31 for routine mammogram)
✅ Confirm payer rules on frequency limits
✅ Append modifiers when screenings turn diagnostic

Small coding errors = denied claims. Accuracy ensures patients don’t face unexpected bills for preventive care.

10/02/2025

The government shutdown isn’t just about closed parks and furloughed workers — it’s quietly slowing down parts of healthcare too. Medicare and Medicaid may keep paying claims, but appeals, audits, and policy updates are hitting pause.

👩‍⚕️ For physicians, that means potential cash flow friction and hidden delays.

👉 Read our latest blog to see what this shutdown really means for your practice: https://callidusbilling.com/blog/

10/01/2025

🎀 October is Breast Cancer Awareness Month

Early detection saves lives — and accurate billing ensures patients have access to the screenings and care they need.

For practices, this means:

- Staying current with ICD-10 coding for breast cancer screenings & treatments
- Navigating payer rules for mammography and preventive services
- Ensuring compliance so care is covered, not delayed

As the month begins, let’s raise awareness and also reinforce the importance of precise billing to support timely patient care.

09/29/2025

CMS Releases Proposed 2026 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) has issued the proposed rule for the 2026 Medicare Physician Fee Schedule. If finalized, the changes would take effect January 1, 2026.

Highlights include:

- A proposed conversion factor reduction to $32.05 (down from $32.36 in 2025)
- Continued telehealth coverage, with some pandemic-era flexibilities winding down
- Updates to Evaluation & Management (E/M) coding and other service refinements
- Expanded focus on value-based care and Quality Payment Program (QPP) participation

📄 Full proposed rule: https://www.federalregister.gov/documents/2025/07/16/2025-13271/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other?utm_source=

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a rule finalizing changes for Medicare payments under the PFS and other Medicare Part B policies, effective on or after January 1, 2025.The CY 2025 PFS final rule is one of several final rules that reflect a broader Admin...

09/15/2025

In the Philippines, patients in government hospitals are walking out with zero balances owed under the country’s new Zero-Balance Billing program. Nearly 300,000 people have already benefited, with billions in medical costs fully covered.

In our latest blog, we explore what U.S. practices can learn from this bold initiative—why billing innovation is just as critical as medical innovation.

https://callidusbilling.com/blog/

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