MBC Billing Company

02/16/2026

Billing Topic of the Day: Out-of-Network Denials Why do claims get denied as out-of-network — even when you’re in-network?
Here are the top causes we see every week:

🔹 Modifier or taxonomy mismatch
Claims billed with incorrect modifiers (like 95 vs GT) or taxonomy codes can trigger auto-denials, even for contracted providers.

🔹 Algorithmic misclassification
Some payers use automated systems that flag claims as out-of-network based on NPI, POS, or billing structure — not actual contract status.

🔹 Authorization confusion
Even when care is medically necessary, lack of referral or prior auth can lead to denial. This is especially common with telehealth and specialty services.

🔹 Payer cost-saving tactics
Out-of-network denials are often used to reduce payout — even when no in-network alternative exists.

🔹 Billing under the wrong plan or NPI
Submitting under a secondary NPI or incorrect plan ID can cause the system to misroute the claim.

02/16/2026

Doulas, your care is essential. Your billing and credentialing should be, too.
We now offer specialized support for doulas navigating insurance, Medicaid, and multi-state compliance.

Whether you’re just getting started or expanding your practice, we handle the paperwork so you can focus on your clients.

📌 Credentialing made simple
📌 Billing that actually gets paid
📌 Support that understands birthwork

DM us today or tap the link in bio to get started.
Let’s make your practice as strong behind the scenes as it is in the delivery room.

01/19/2026

01/17/2026

We clean up the mess. You collect the revenue!

01/15/2026

Every CPT code tells a story — 97153 reflects direct ABA treatment, 92507 captures speech therapy, and 97530 defines therapeutic activities. Accurate coding isn’t just billing — it’s clinical integrity.

01/14/2026

Don’t forget to step outside today—let the world steady you and bring you back to yourself. 🌊☀️

01/05/2026

📣 Florida Providers — New Refund Law Alert!
Starting January 1, 2026, all licensed healthcare entities must refund patient overpayments within 30 days of identifying them.

🔹 Applies to providers, facilities, and billing companies
🔹 Penalties up to $500/day for delays
🔹 Disciplinary action possible for noncompliance

This is not about insurance refunds — it’s about protecting patients and tightening compliance.

💡 Tip: Review your refund workflows now. Automate alerts. Document determinations. Stay audit-ready.

HealthcareLaw MBCBilling

01/04/2026

A clean AR is a clear path to growth. Let MBC Billing Company help you start strong.

01/02/2026

🏥 UHC January 2026 Reimbursement Updates – At a Glance

🔹 Off-Campus Facility Billing (Modifier PO)

• Starting March 1, 2026, UHC will reduce payment by 60% for G0463 billed with PO modifier, aligning with CMS.
• Applies to outpatient services in off-campus hospital departments.
• Exemptions: ER, Critical Access, Rehab, Psych, Long-Term Care, Maryland, Puerto Rico, U.S. territories, Rural Sole Community, IHS.

🔹 Routine Testing Management Policies

• Effective April 1, 2026 in NC, NE, RI.
• New limits on lab tests like Vitamin D, Lyme, Diabetes, Iron, Autoimmune, GI, and more.
• Vitamin D: Max 4 tests/year, must have valid ICD-10 diagnosis.

🔹 Radiology Interpretation Rules

• Starting April 1, 2026, if no full written report is submitted, radiology interpretation is bundled into E/M — no separate pay.
• Applies to global codes and modifier 26.

🔹 Anatomical Modifiers Required

• From Feb 1, 2026, surgical and radiology codes must include correct laterality/digit modifiers (e.g., LT, RT, F1–F9, T1–T9).

🔹 Diagnosis Coding Enforcement

• Excludes 1 rules will apply to all claim types starting March 1, 2026.
• Claims with mutually exclusive codes will be denied.

🔹 Code Set Updates

• CPT, HCPCS, ICD-10, and modifier lists updated across multiple policies.

01/01/2026

🧭 Start 2026 With Clarity, Confidence & Clean Revenue

Providers — if your billing company isn’t showing you monthly KPIs and where your revenue is going, it’s time for a change.

At MBCBilling Company LLC, we don’t just submit claims.
We track, report, and optimize your revenue with:

✅ Monthly KPI dashboards
✅ Denial trends and payer insights
✅ Compliance-focused billing that protects your practice
✅ Transparent reporting you can actually understand

We’re trusted to represent providers in sensitive patient scenarios — because we know modifiers, global periods, and payer-specific rules inside and out.

📈 Our clients see faster reimbursements, cleaner claims, and fewer surprises.

Let’s review your 2025 performance and set you up for a stronger 2026.
📩 DM to schedule your free Revenue Review.

12/25/2025

May your holidays be filled with peace, purpose, and the promise of new beginnings. From the Hurtado Family 🎄❤️