Callidus Billing, Inc.

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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09/12/2025

Billing Tip Friday
Every payer has its own timely filing limit—sometimes as short as 90 days. Miss that window, and you risk losing reimbursement completely.

👉 Don’t leave money on the table:

- Track deadlines for each payer
- Set reminders in your billing system
- File early to avoid last-minute denials

At Callidus Billing, we help practices stay ahead of the clock—so every claim gets its chance to be paid.

09/10/2025

🚫 Myth: “Outsourcing billing means losing control of my revenue.”
✅ Reality: Outsourcing gives you more control, not less—through transparent reporting, cleaner claims, and predictable cash flow.

At Callidus Billing, we believe in partnership, not guesswork:

- Transparent, real-time reporting 📊
- Faster claims + fewer denials ⏱️
- Lowest outsourcing fees in the industry 💵

With us, you see every number. The only thing you lose is the admin headache.

📞 Ready to take back control of your revenue cycle? Let’s talk.

09/08/2025

Health Insurance Premiums Are About to Jump—Big Time

Starting in 2026, Americans will see the largest increase in health insurance costs in 15 years:

- Employer plans: +6.5%
- ACA exchange plans: +18%

What this means for practices:

- More patients struggling with out-of-pocket costs
- Longer A/R cycles
- Heavier reliance on payment plans

Premium hikes aren’t just an insurance story—they’re a billing challenge. Practices that prepare now will navigate the storm better than those that wait.

Read more here:

Rising premiums add to pressure on households already feeling the pinch from the high price of goods

08/25/2025

💡 CMS Proposes 2026 Medicare Physician Payment Changes

The Centers for Medicare & Medicaid Services (CMS) has released its 2026 Physician Fee Schedule proposed rule — and while the reimbursement bump looks modest, the framework signals bigger changes on the horizon.

This proposal leans into the “Big Beautiful Bill” model, reshaping how physician payments are calculated. The key takeaway? Providers and billing teams need to stay alert: reimbursement structures are shifting, and preparation now means fewer surprises later.

At Callidus, we’re already reviewing the rule so our clients can focus on patient care — while we handle the revenue cycle details.

👉 Read the full story here: https://www.healthcaredive.com/news/medicare-2026-physician-payment-proposed-big-beautiful-bill/753033/

08/15/2025

Double-Check Your Modifiers Before You Hit Submit

Modifiers like 25, 59, and the -X{EPSU} set are among the most common reasons claims get flagged for review — or denied outright.

✅ Make sure documentation supports the modifier use
✅ Avoid adding modifiers “just in case” — it’s a compliance risk
✅ Review payer-specific modifier rules before submission

💡 Clean claims start with accurate coding AND justified modifiers.

08/13/2025

🧾 When Your Billing Team Hits a Wall, We Break Through

Every billing team has them — the stubborn claims that refuse to get paid. They’re denied, appealed, resubmitted… and still sitting there.

That’s where Callidus Billing comes in.

🔹 Keep your in-house team
🔹 Send us the claims they can’t resolve
🔹 We dig in, work the appeal, and push it through

From aged A/R to complex denials, we handle the claims that take time, persistence, and deep payer know-how. Whether it’s five claims or fifty — we go after every last dollar.

📬 Backup billing when you need it. No contracts, no drama.

08/11/2025

AI isn’t coming to healthcare — it’s already here.
It’s in our billing systems, our prior authorizations, our claims processing… and it’s learning faster than we think.

CMS’s AI prior auth pilot is just the beginning. The bigger question?
When machines make more of our decisions, will we still be in control — or just the data they’re trained on?

Read the full blog here 👉 https://callidusbilling.com/blog/

08/11/2025

📢 MONDAY MEDICAL BILLING UPDATE
Medicare to Test AI for Prior Authorizations in 2026

CMS will launch a pilot in six states using AI-assisted prior authorization for select traditional Medicare services.
Clinicians will still sign off on approvals, but AI will flag cases for review — which could slow turnaround times if documentation isn’t complete.

📄 Read the full article here: https://shorturl.at/OoHVV

Increasing prior authorizations would “undercut one of the immense benefits of traditional Medicare.”

08/01/2025

📘 Billing Tip Friday

Stop Denials Before They Start.

Before you submit that claim, check the LCD (Local Coverage Determination) or NCD (National Coverage Determination) — especially for:

🧪 Labs
🩻 Imaging
🩼 DME
🧠 Behavioral health

These services often come with strict coverage guidelines and ICD-10 code requirements.

🧾 If the diagnosis doesn’t match what the payer expects, it’s an instant denial — no matter how perfect your coding is.

💡 Pro tip: Bookmark your top 3 MAC portals and check for updates weekly.

07/30/2025

🧾 Your Billing Team Handles Most Claims. We Handle the Ones That Don’t Budge.

If you're sitting on claims that just won’t get paid — denials, rejections, or that one code payers love to bounce back — don’t keep spinning your wheels.

Let Callidus Billing step in.

✅ You keep your current billing team
✅ We take on the select claims you're stuck on
✅ No contracts, no overhaul — just clean-up and results

We specialize in:

- Hard denials
- Aged A/R recovery
- Claims that need appeals, persistence, and deep payer knowledge

Whether it’s 3 claims or 30 — we’ll fight for every dollar.

📬 Backup billing. No commitment. Just resolution.

07/28/2025

🗓️ MONDAY MEDICAL BILLING UPDATE

UnitedHealth Faces DOJ Probe Over Medicare Advantage Billing

Federal prosecutors are investigating allegations of inflated diagnosis codes and risk score manipulation tied to UnitedHealth's Medicare Advantage plans.

🚨 This has major implications — not just for UHC providers, but for anyone billing Medicare Advantage.

📌 What You Should Do This Week:

- Audit high-RVU and chronic diagnosis codes
- Ensure documentation supports severity and specificity
- Review templated EHR notes — they’re a red flag in audits
- Educate providers on compliant HCC coding practices

💡 Even one unsupported diagnosis can trigger a payer audit.

🔗 Read more (WSJ, paywall) https://www.wsj.com/business/unitedhealth-doj-medicare-billing-investigation-8d56800d

Justice Department prosecutors recently interviewed former employees about company practices that boost federal payments.