June 19, 2026

In this episode, Scott, Mark, and Dr. Ray Painter tackle three challenging reimbursement scenarios submitted by listeners: Medicare denials for category III code 0816T, handling patient payments when claims are denied for timely filing or missing prior authorizations, and the ongoing complexities of billing urodynamics studies in a group practice setting. The discussion explores why “unprocessable” claims often require deeper investigation, how payer contracts influence whether patient payments must be refunded, and the pros and cons of global versus split billing for urodynamics services. The key takeaway: many reimbursement problems are not coding issues at all—they are workflow, contract, and claim-processing issues that require practices to understand both the rules and the business side of medicine.

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