BeInRev Medical Solutions

05/15/2026

Most billers have never used POS 99.

Here's when you should.
When a service is rendered somewhere that doesn't fit any existing place of service code, you don't guess.

You don't force it into the closest option.

You use POS 99 - Other Place of Service.

That's exactly what it was created for.

Real examples where POS 99 is the right call:
- Medical adult day care centers
- Employer-sponsored wellness sites
- Community health fair settings
- Correctional facilities without a designated POS

What it is NOT:
❌ A substitute for POS 12 just because the patient is homebound
❌ A workaround when you're simply unsure
❌ Interchangeable with other codes that actually fit

One more thing, POS 99 is typically treated as a non-facility setting. That means the higher non-facility payment rate. Know that before you bill.

And before making it routine,
➡️ Call your MAC.
➡️ Document the call.
➡️ Rep name, date, reference number.
➡️ Every time.

The right POS code is the one that accurately describes reality.

05/12/2026

Do You Need Modifier 25 When Billing an E/M with In-Office X-Rays?

Short answer: No!

Here's why -
Modifier 25 exists to separate an E/M from a same-day procedure that has a global period (like nail debridement or a minor surgery). It tells the payer: "This E/M was significant and separate from the procedure."

Diagnostic X-rays don't have a global period. They carry a global indicator of "###" in the Medicare fee schedule, meaning the global surgery concept doesn't apply to them at all. There's nothing to unbundle from, so modifier 25 is unnecessary.

Just bill:
Your E/M (99213, 99214, etc.) - no modifier needed

Your X-ray code(s) - no modifier needed

Where 25 IS required in podiatry?
- E/M + nail debridement (11720/11721) same day

- E/M + corn/callus removal (11055-11057) same day

- Any E/M + minor procedure with a 0 or 10-day global

The rule is simple: procedures with global periods need the 25. Diagnostic tests don't.

05/08/2026

IN-NETWORK Provider + OUT-OF-NETWORK Facility = Payment Nightmare?

You're credentialed at the hospital. You're in-network with the patient's UHC Medicare Advantage plan. But the hospital itself? It's Out-of-Network.

Do you get paid your contracted rate or does the claim vanish into the "0ON Denial"?

Here is what happens:

Your contract with the payer (UHC) generally dictates your payment, BUT automated claim systems often trigger a denial because the Place of Service (POS 21) NPI doesn't match the payer's network directory.

3 Steps to Protect Your Inpatient Claims:

1. Check the "Consult" Rule - Most commercial payers often still accept 99252-99255, unlike traditional Medicare. Using the wrong code triggers a "not a covered benefit" denial before they even look at your network status.

2. Verify the Stay Auth -Even if you are INN, if the hospital didn't get the inpatient stay authorized, your specialty consult might get swept into a global denial.

3. Document the Request - Audit-proof your note by naming the requesting MD (e.g.. "Consulted by Internal Medicine for limb-salvage evaluation").

Pro Tip: Don't let the "OON Facility" label scare you. If you're INN with the plan, you are entitled to your contracted rate, but you might have to fight a "Level 1 Appeal" to prove it.

Call now to connect with business.

10/24/2025

At BeInRev Medical Solutions we often see practices collect a “standard copay” at check-in, only to find later via the EOB that the patient actually had no payment responsibility for that service.

Here’s one recent real-life example: a podiatry patient came in, the front desk collected the usual copay shown on the card. After the claim processed the explanation of benefits showed zero owed by the patient. Why? Because the benefit for that specialty visit carried no copay (for that plan) and the deductible/coinsurance didn’t apply.

This kind of mismatch creates more work: reversing collections, explaining to patients, and potentially eroding trust. The better route: verify both eligibility and the benefit details for that exact service type before collecting.

If your practice has ever wondered “why did we collect when the patient owed nothing?”, you’re not alone — and it’s fixable.

10/22/2025

Is your practice unintentionally leaving revenue on the table?

If your A/R is rising, the problem might be your patient collections process. Too many private practices are trying to collect 21st-century patient balances with 20th-century methods (71% still use paper/manual processes!). This adds stress to your staff and friction to the patient experience.

Learn the simple, 3-step system that top-performing practices use to collect copays before the patient even sees the doctor. Collect what you’ve earned, build patient trust, and reduce your AR days by up to 27%.

Read the full system details here and stop the leak today! Full blog here -

Stop losing revenue to uncollected copays. Implement a clear, 3-step RCM system for guaranteed copay collection, improved cash flow, and reduced AR days.

10/19/2025

Is Your Practice on a Cash Flow Treadmill? The A/R Management Secret.

We've all seen the scenario: Your staff is overwhelmed, and you're working hard, but the money is always lagging. The problem is usually simple: your Accounts Receivable (A/R) aging process is out of control.

You must accept the brutal math: the longer a claim sits, the less likely you are to get paid. A denied claim that bounces around for 90 days is far more likely to be written off than a claim followed up within 30 days. This financial decay is the root cause of cash flow shortages and staffing inefficiency.

The Solution: Focus on your "front door." Ruthlessly enforce patient eligibility and benefit verification. This single step eliminates the vast majority of preventable denials, keeping your claims "clean" and ensuring they pay quickly. If you want a predictable revenue cycle, you need a predictable intake process.

Ready to find out if your A/R is dragging you down? We break down the 4 simple, non-salesy steps to stabilize your cash flow and hit the industry benchmark of under 30 Days in AR.

Click here for the full blog post: https://www.beinrev.com/post/the-90-day-rule-why-fast-a-r-management-is-the-only-way-to-protect-your-private-practice-revenue

10/08/2025

The Denial Crisis is Not a Staffing Problem. It’s a System Problem.

If your initial claim denial rate is over 10%, you are paying a massive administrative tax on your success.

The hidden cost isn't the claim itself; it's the $25–$181 it costs in staff time to rework each denial. And 60% of those claims are never even resubmitted. That’s your practice's "Porsche Drawer" of lost revenue.

The solution isn't hiring more people; it's fixing the process.

The Fix is a 3-Step System:

Lock the Front Door: Mandate 100% pre-service verification of eligibility, benefits, and prior authorization (PA) at patient intake. This eliminates the #1 cause of denials.

Diagnostic Focus: Train your team to immediately decode the denial reason (CO-11, etc.) in the EOB/ERA, moving them from guesswork to correction.

Prioritize Profit: Work your A/R report by focusing only on high-dollar claims that are near the timely filing deadline. Stop chasing nickels when a thousand dollars is about to be lost forever.

I shared the full breakdown of how to implement these systems and recover thousands in lost revenue here -> https://www.beinrev.com/post/the-porsche-drawer-why-your-practice-is-leaving-44-000-on-the-exam-table

10/08/2025

Is your Accounts Receivable (AR) making you nervous? 💸

Most practice owners know the number—the total money owed by payers and patients. But do you know the Days in AR? If that number is over 50, it's a red flag signaling major cash flow trouble. You earned the money; now it's time to create the system that brings it home.

We see two critical mistakes practices make:

The Front-End Fail: Claims are rejected because of simple intake errors. Missing Prior Authorization (CO-15) or an expired policy (CO-27) means a guaranteed denial and wasted staff time. This needs to be a mandatory check before the patient sees the doctor.

The Passive Follow-Up: Letting claims "sit" until they are 60 or 90 days old. You must be proactive. Work your Aging Report weekly, prioritizing the biggest claims and those nearing the payer’s timely filing deadline.

High-performing practices keep their AR under 45 days. This isn't magic; it's process. Stop chasing old money and start preventing new debt from building up.

I shared the full strategy to reset your AR and improve cash flow here → https://www.beinrev.com/post/a-simple-system-to-cut-your-practice-s-ar-and-collect-what-you-earn

09/28/2025

⚠️ Stop! Are you collecting copays from patients with Commercial Primary and Medicaid Secondary insurance? You shouldn't be.

This is one of the most common—and most risky—billing mistakes private practices make.

When a patient has dual coverage (Commercial primary, Medicaid secondary), the Medicaid Payer of Last Resort rule kicks in. This means:

The Commercial plan pays their portion.

The remaining copay, deductible, or coinsurance is billed to Medicaid.

Medicaid evaluates the claim. If the primary payment meets or exceeds Medicaid’s allowed fee, the patient's remaining liability is legally zeroed out.

If you collect that copay, you are engaging in improper balance billing, which violates your Medicaid provider agreement and puts your practice at risk for audits and fines.

The Fix is Simple:

Front Desk: Verify both insurances and inform the patient they will have no copay today.

Billing: Bill Commercial first, then ensure the claim crosses over correctly to Medicaid.

Post-Payment: Write off the remaining patient balance after Medicaid processes the claim. Do not send a statement.

Protect your practice's compliance and revenue. Don't let this simple billing error cost you thousands.

👉 Read the full guide on how to handle dual-eligibility claims correctly https://www.beinrev.com/post/medicaid-as-secondary-do-you-ever-collect-a-copay

The Surprising Truth About Medicaid & Commercial Copays It's a common scenario. A patient shows up for an appointment with two insurance cards: a commercial plan as primary and a Medicaid card as secondary. The commercial EOB (Explanation of Benefits) comes back, showing a $30 copay and a $150 remai...

01/19/2024

The Centers for Medicare & Medicaid Services (CMS) recently implemented a new rule affecting prior authorizations and data sharing.
Read more about the rule and its potential effects in the linked article below.
Link to the article: https://www.cms.gov/.../cms-finalizes-rule-expand-access...