The Ashez Group. Medical Billing & RCM Expert

09/08/2026

CODING PEARL: Don't Automatically Add Modifier 26

A provider interprets a diagnostic test but doesn't own the equipment.

Should you bill the full CPT® code?

Often, no.

Many diagnostic services have two components:

🩺 Professional Component —Modifier 26
The physician/QHP performs the interpretation and prepares the report.

🏥 Technical Component — Modifier TC
Covers items such as equipment, technician, supplies, and other technical resources.

📌 Example: EKG

93000 → Complete EKG (tracing + interpretation/report)

93005 → Tracing only, without interpretation/report

93010 → Interpretation and report only

🚨 Common Revenue/Compliance Mistake.

A provider performs only the interpretation but the practice bills 93000 as though it provided both components.

Or the opposite: the practice owns the equipment, performs the tracing and interpretation, but bills only the professional portion and potentially leaves legitimate revenue uncaptured.

💡 Provider Tip

Before billing a diagnostic service, ask:

Who owns/performs the technical portion?
Who performs and documents the interpretation?**

Then select the code/component that represents the service actually provided.

⚠️ Not every CPT® code can be split with 26/TC, and payer rules matter.

Don't just code the test. Code your role in the test.

📞 844-824-4040
🌐 theashezgroup.com

09/04/2026

🏥 Your Practice Should Focus on Patient Care, Not Chasing Claims.

Delayed payments, credentialing backlogs, denied claims, and aging A/R can quietly drain your practice's time and revenue.

The Ashez Group provides reliable, scalable support to help healthcare providers build a stronger revenue cycle.

Our Services

✓ Medical Billing & Coding
✓ Credentialing & Payer Enrollment
✓ Denial Management & Appeals
✓ A/R Follow-Up & Revenue Recovery
✓ Eligibility & Benefits Verification
✓ Prior Authorization Support
✓ **Virtual Medical Assistance**
✓ **Complete Revenue Cycle Management**

🏅 Certified & Trusted

⭐ Certified Woman-Owned Business
⭐ WBENC Certified
⭐ WOSB Certified
⭐ Virginia SWaM Certified
⭐ SBA Certified

📍 Based in Virginia | 🇺🇸 Serving Healthcare Providers Nationwide

Less administrative stress. Fewer revenue leaks. A stronger practice.

📞 844-824-4040
✉️ [email protected]
🌐 theashezgroup.com

09/02/2026

🧠 Mental Health Billing: Codes & Modifiers Providers Should Know

Mental health billing gets complicated when psychotherapy, medication management, and telehealth overlap. A small coding mistake can turn a valid service into a denial.

📌 Common CPT Codes

90791 — Psychiatric diagnostic evaluation without medical services
90792 — Psychiatric diagnostic evaluation with medical services
90832 — Psychotherapy, 16–37 minutes
90834 — Psychotherapy, 38–52 minutes
90837 — Psychotherapy, 53+ minutes
99213–99215 — Established-patient E/M services
90833 / 90836 / 90838 — Psychotherapy add-on codes used with an eligible E/M service

💡 Modifier & POS Tips

✔ Modifier 95 — Commonly used for synchronous telehealth when required by the payer.
✔ POS 10 — Patient receives telehealth in their home.
✔ POS 02 — Patient receives telehealth somewhere other than their home.
✔ Don't automatically add Modifier 25 when psychotherapy and E/M are billed together; follow CPT and payer rules for the specific services.

🚨 One Important Tip:
When billing E/M + psychotherapy, keep the work distinct. The E/M documentation should support medication/medical management, while psychotherapy documentation should support the separate psychotherapy service and time.

Example:
99214 + 90833 may be appropriate when a qualifying E/M service and 16–37 minutes of psychotherapy are both performed and documented.

Better coding isn't about billing more—it's about capturing the services actually performed and supporting them correctly.

📞 844-824-4040
🌐 theashezgroup.com

08/27/2026

🚨 BILLING PEARL: A Rejected Claim Is NOT a Denied Claim

They may sound similar—but they happen at completely different stages of the revenue cycle.

❌ REJECTED CLAIM

The claim usually fails before adjudication because something is wrong with the claim data.

Common causes:

• Invalid/missing member ID

• Incorrect NPI or taxonomy

• Missing required claim information

• Invalid CPT®/ICD-10 data

• Electronic claim formatting errors

👉 Next move: Correct the error and resubmit promptly.

🚫 DENIED CLAIM

The payer received and adjudicated the claim but determined that payment should not be made as submitted.

Common causes:

• Medical necessity

• No authorization

• Non-covered service

• Bundling

• Timely filing

• Eligibility/coverage issues

👉 Next move: Review the ERA/EOB, identify the denial reason, then correct, reconsider, or appeal as appropriate.

Blindly resubmitting a denied claim without fixing the underlying issue can create duplicate claims while the original problem remains unresolved.

📌 The smarter workflow:

Rejected → Fix the claim data → Resubmit

Denied → Find the root cause → Correct/Appeal → Track to resolution

🔥 One word can completely change your follow-up strategy.

Save this for your next A/R meeting.

📞 844-824-4040

🌐 theashezgroup.com

08/24/2026

💡 NPI-1 vs NPI-2 — A Small Difference That Can Cause Big Billing Problems**

👨‍⚕️ NPI-1 identifies the individual provider who renders the service.

🏥 NPI-2 identifies the healthcare organization or group that may bill the payer.

⚠️ **Important:** Getting an NPI-2 does **not** automatically credential your practice with insurance companies.

Before billing, verify:
✅ Rendering provider NPI-1
✅ Billing organization NPI-2, when applicable
✅ Provider-to-group affiliation
✅ Correct taxonomy
✅ TIN/NPI enrollment with the payer

**Correct NPI setup = Cleaner claims + Fewer enrollment-related denials.**

📞 **844-824-4040**
🌐 theashezgroup.com

08/20/2026

💎 CODING PEARL: PHQ-9 ≠ Automatic 96127

A completed depression screening doesn't automatically mean **CPT® 96127 should be billed.

Before submitting, confirm:

✅ Standardized tool was administered
✅ Screening was scored
✅ Results are documented
✅ Clinical context supports the service
✅ Payer coverage and unit limits are verified

💡 Provider Tip:** Don't just document PHQ-9 completed. Record the **tool, score, interpretation, and follow-up plan.**

Better documentation. Cleaner claims. Stronger reimbursement.**

📞 844-824-4040
🌐 theashezgroup.com

08/18/2026

💰 **Could Hidden Billing Errors Be Costing Your Practice Thousands?**

Even small mistakes in coding, documentation, eligibility verification, or claim submission can lead to **claim denials, delayed payments, and lost revenue**.

Our latest guide, **Medical Billing Audit Checklist: 25 Costly Mistakes Every Practice Should Avoid**, walks you through a comprehensive audit process to help your practice:

✅ Identify hidden revenue leaks
✅ Improve clean claim rates
✅ Reduce claim denials
✅ Strengthen coding compliance
✅ Maximize insurance reimbursement

📥 Plus, download our **FREE Medical Billing Audit Workbook** to evaluate your revenue cycle and uncover opportunities for improvement.

📖 Read the full blog:
🌐 https://theashezgroup.com/medical-billing-audit-checklist/

📞 844-824-4040

Learn the ultimate Medical Billing Audit Checklist with 25 costly mistakes to avoid, improve claim accuracy, reduce denials, strengthen compliance, and maximize reimbursement.

08/13/2026

Your Practice Doesn't Have a Revenue Problem... It Has a Visibility Problem.

You can't bill for services you never identify.

Every day, practices miss legitimate reimbursement opportunities—not because they aren't providing excellent care, but because eligible services aren't recognized, documented, or captured correctly.

Ask yourself:

✅ Are eligible Medicare patients receiving their Annual Wellness Visits?

✅ Are you appropriately capturing **G2211** for longitudinal, complex patient care?

✅ Are patients who qualify for **Chronic Care Management (CCM)** being enrolled and documented?

✅ Are **Advance Care Planning (ACP)** conversations being billed when all requirements are met?

✅ Are **behavioral health screenings** being documented and reported when appropriate?

💡 **Advice for Practice Owners:**

Before trying to see more patients, audit the care you're already providing. You may discover that your practice is delivering services that qualify for reimbursement—but they're never making it onto the claim.

Sometimes, increasing revenue isn't about working harder—it's about capturing the full value of the care you already provide.

📞 844-824-4040

🌐 http://www.theashezgroup.com

08/10/2026

How Much Revenue Is Your Practice Leaving on the Table?

Most practices focus on **claim denials**.

The practices that grow faster focus on **services they never billed in the first place.**

Here are **5 commonly overlooked revenue opportunities** that may already be happening in your practice—but never make it onto a claim.

💰 **Annual Wellness Visits (AWV)**
Many Medicare patients qualify every year, but the visit is never scheduled or billed.

💰 **G2211**
If you're managing a patient's ongoing, complex care, this add-on code may be appropriate—yet many eligible visits are submitted without it.

💰 **Chronic Care Management (CCM)**
Patients with multiple chronic conditions may qualify for monthly care management services when documentation and program requirements are met.

💰 **Advance Care Planning (ACP)**
Discussions about future healthcare decisions can be separately billable when all documentation requirements are satisfied.

💰 **Behavioral Health Screenings**
Validated screening tools for depression, anxiety, substance use, and other behavioral health concerns may be reimbursable when performed and documented appropriately.

⚠️ **Here's the biggest mistake we see:**

Practices often assume that seeing more patients is the only way to increase revenue.

In reality, many practices can improve reimbursement simply by ensuring **appropriate, properly documented services are identified and billed.**

📞 **844-824-4040**