The ledger
Notes from the claim queue
Practical answers for billers and practice managers, with real numbers and no filler. The pieces we wish had existed when we were the ones fighting the software.
Latest articles
Do I Need a Clearinghouse, and What Does One Cost?
What the clearinghouse function actually does, whether it is a separate bill, real 2026 prices, and the payer enrollment step that surprises everyone.
Read the explainer →Can I Bill an E/M and a Procedure the Same Day? Modifier 25
When the office visit is separately billable, when it bundles, and why modifier 25 is the most-audited element in the book.
Read the answer →Medical Billing Software Pricing in 2026: Real Numbers, No Contact Sales Button
What fifteen vendors actually charge, from RXNT to Tebra, and the line items the quotes leave out. With the prices six of them will not print.
Read the survey →What Percentage Do Medical Billing Companies Charge? 2026 Benchmarks
The 4 to 10 percent market, the 6 to 7 percent mode, and, if you run the billing company, how to set a rate that survives a slow month.
Read the benchmarks →How to Start a Medical Billing Company From Home in 2026
The real startup budget, HIPAA compliance at the kitchen table, the pricing-model decision, and the honest path to your first three clients.
Read the guide →Rejected vs Denied Claims: The Difference, and How to Fix Each
Where each one happens, why the fix is different, the ten rejections billers see most, and the denial codes worth memorizing.
Read the breakdown →Reference tools
Keep these open in a tab
Timely Filing Limits by Payer
The payer-by-payer deadline table, with clock-start rules and what to do when you miss one. Verified July 2026.
Open the cheat sheet →The Break-Even Calculator
Outsourcing at a percentage of collections against in-house software, plus what your denial rate costs. Answers on the page.
Run the numbers →The Denial Code Decoder
CO-16, CO-45, CO-97, PR-204 and 30 more, in plain English with who owes the balance and the fix for each.
Decode a remit →The Days in A/R Calculator
Two numbers from your aging report, benchmarked against the under-35-day standard, with the levers that move it.
Check your number →The 8-Minute Rule Calculator
Enter your timed therapy minutes and get the correct Medicare units, including the code-by-code split that most billers get wrong.
Count the units →Can I Bill These Two Codes Together?
The code pairs billers search most, with the verdict and the modifier for each: what needs a 25, what needs a 59, what you cannot bill at all.
Check a pair →Billing by specialty
The rules that only your specialty fights
Code-level guides for the denials, modifiers, and coverage traps specific to how you bill. Written for the person in the practice who handles the claims. See all specialties.
Mental Health & Therapy Billing
90837 vs 90834, the interactive-complexity add-on, telehealth POS 10 vs 02, and the 2024 Medicare change for LPCs and LMFTs.
Read the guide →Physical, Occupational & Speech Therapy Billing
The 8-minute rule worked, the KX threshold, the discipline modifiers, and the NCCI edits that bundle your second code.
Read the guide →Chiropractic Billing & the AT-Modifier Trap
What Medicare actually covers, the AT modifier, the subluxation diagnosis, and ABN modifiers GA, GY, and GZ.
Read the guide →ABA Therapy Billing
The 97151 to 97158 family in 15-minute units, authorization caps, concurrent 97153 and 97155 billing, and the credential modifiers.
Read the guide →Optometry & Eye Care Billing
The medical-versus-vision routing decision, refraction 92015, the 92133/92134 rule, and cataract co-management.
Read the guide →Podiatry Billing & Routine Foot Care
The routine foot care exclusion, the Q7/Q8/Q9 class-findings modifiers, the date-last-seen rule, and toe modifiers.
Read the guide →The best guide is a free trial
Read all you like, then run your own claims through it for thirty days. No credit card, no sales call.
30-day free trial · No credit card · No sales call