Uncategorized Archives - Revenant Care

CO-197 reads: precertification, authorization or notification absent. It is the most written-off denial in behavioral health and substance use treatment, and it is also the one with the largest genuinely recoverable balance sitting inside it. Those two facts are related — the pile is big because nobody works it. The reason is understandable. CO-197 feels […]

G0402 vs G0438 vs G0439: The Medicare Wellness Visit Denial You Can’t Rebill

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Three codes, one patient, one calendar year, and a denial that cannot be fixed by rebilling. This is the costliest sequencing error in primary care. G0402 — the Welcome to Medicare visit. Once per lifetime, and only within the first 12 months of Part B enrolment. G0438 — the initial Annual Wellness Visit. Once per […]

97153 vs 97155: The ABA Billing Error That Downcodes Your BCBAs

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This is the most expensive coding confusion in ABA, and it almost always costs money in the same direction: work done by a BCBA gets paid at technician rates. 97153 is adaptive behavior treatment by protocol. A technician delivers a plan someone else wrote. Technician rate. 97155 is adaptive behavior treatment with protocol modification. A […]

99417 vs G2212: Which Prolonged Services Code Your Payer Actually Wants

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Two codes describe the same thing: time you spent on an office visit beyond what the primary E/M code covers. Bill the wrong one to the wrong payer and it denies every time. 99417 is the CPT code. Most commercial payers want it. G2212 is the HCPCS code Medicare created because CMS disagreed with how […]

CO-97 Denial Code: Why It Hits Modifier 25 Claims and How to Fix It

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CO-97 reads: “The benefit for this service is included in the payment/allowance for another service or procedure that has already been adjudicated.” In plain terms: the payer decided you already got paid for this. Not that the service was unnecessary. Not that documentation was missing. That it was part of something else on the claim. […]

Silent Repricing 2026: Payer Downcoding, Modifier 25 Reductions, and CO-45 Write-Offs

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The payer playbook has shifted. Where claims used to deny – creating a work queue and an appeal – they increasingly pay at a reduced amount instead. Reductions generate no queue, no appeal deadline, and no visibility. This guide covers the three silent repricing mechanisms hitting physician groups in 2026. Algorithmic E/M Downcoding Several national […]

TCM and CCM Billing 2026: Turning Care Coordination Into Claims

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Transitional care management and chronic care management are the two service lines primary care practices most consistently deliver without billing. Both pay well. Both have documentation requirements that fail silently – no claim is created, so no denial ever flags the loss. TCM: 99495 and 99496 The requirements: interactive contact with the patient within two […]

Split/Shared Visit Billing 2026: Substantive Portion Rules and the 85% Trap

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Split/shared visits – where a physician and an advanced practice provider both participate in a facility E/M encounter on the same day – are governed by the substantive portion rules, and getting the documentation wrong silently reprices the encounter at 85% of the fee schedule. What the Rule Requires The visit bills under whichever clinician […]

Provider Enrollment Lag 2026: The 60-150 Day Gap That Books as Bad Debt

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When a physician group hires, the new provider starts seeing patients on day one – but payer enrollment becomes effective 60 to 150 days later depending on the payer. What happens to the claims in that gap determines whether the group loses a quarter of that provider revenue. The Three Bad Options Hold the claims, […]

HCC Recapture for Primary Care 2026: The Payment Cut That Arrives a Year Late

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For primary care groups with Medicare Advantage or ACO revenue, the largest revenue mechanism is not a claim at all – it is the risk adjustment factor, and the way chronic conditions silently fall out of it. Conditions Do Not Carry Forward A diabetic with complications, a patient with CHF, a patient with COPD – […]

Revenant Care

Category: Uncategorized

CO-197 Denial Code: The Prior Authorization Money You Can Still Recover

G0402 vs G0438 vs G0439: The Medicare Wellness Visit Denial You Can’t Rebill

97153 vs 97155: The ABA Billing Error That Downcodes Your BCBAs

99417 vs G2212: Which Prolonged Services Code Your Payer Actually Wants

CO-97 Denial Code: Why It Hits Modifier 25 Claims and How to Fix It

Silent Repricing 2026: Payer Downcoding, Modifier 25 Reductions, and CO-45 Write-Offs

TCM and CCM Billing 2026: Turning Care Coordination Into Claims

Split/Shared Visit Billing 2026: Substantive Portion Rules and the 85% Trap

Provider Enrollment Lag 2026: The 60-150 Day Gap That Books as Bad Debt

HCC Recapture for Primary Care 2026: The Payment Cut That Arrives a Year Late