Billing for Medicaid: The Complete 2026 Provider Guide
The CMS FY2025 PERM report just landed. The Medicaid improper payment rate jumped to 6.12%, representing $37.39 billion in improper payments. That’s up from $31.10 billion in 2024. Real money. Gone. And most of it wasn’t fraud. Billing for Medicaid is the process by which healthcare providers submit claims to state Medicaid programs for reimbursement of covered […]
Hyperlipidemia ICD-10 Code E78.5: 2026 Coding and Billing Guide for Healthcare Providers
E78.5 is a billable and specific ICD-10-CM code for hyperlipidemia, unspecified, effective for FY2026 and classified under category E78 (Disorders of lipoprotein metabolism and other lipidemias) per the CDC NCHS ICD-10-CM FY2026 release. It is the default code when documentation lacks the specificity to support a more defined lipid disorder, but it is one of […]
Eligibility Verification & Prior Authorization: Key Differences Every Healthcare Practice Must Know [2026]
A billing coordinator at a busy orthopedic practice picks up the phone and calls the insurance company. “I need to verify the patient’s eligibility for an MRI,” she says. The rep on the other end pauses, then asks: “Do you need eligibility verification or prior authorization?” The coordinator hesitates. Aren’t those the same thing? That […]
Medical Billing vs. Revenue Cycle Management: The Complete Guide for Healthcare Providers [2026]
In 2025, 41% of healthcare providers report denial rates exceeding 10%, up from just 30% three years ago (Experian Health’s 2025 State of Claims Survey). For the average practice, that translates to tens of thousands in lost revenue every single month, with staff burning hours on rework instead of patient care. Here’s what most practice […]
Welcome to Claimmax RCM: The Revenue Partner Your Practice Actually Needs
The business of medicine has changed. I have spent the last 15 years working in the trenches of medical billing. I remember when a handshake and a paper claim were enough to keep a practice running. Those days are gone. Today, providers face a complex maze of payer regulations and administrative hurdles. It feels like […]