Medical Billing

Spravato Billing Alert: Navigating the 2026 Shift from S0013 to J0013

Spravato Billing Alert: Navigating the 2026 Shift from S0013 to J0013 For mental health practices providing Spravato (esketamine), the administrative landscape just shifted. Effective January 1, 2026, the Healthcare Common Procedure Coding System (HCPCS) has undergone a significant update: the longstanding code S0013 has been discontinued and replaced with J0013 (Esketamine, nasal spray, 1 mg). […]

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Insurance Verification: The Non-Negotiable Step That Drives Your Medical Practice’s Cash Flow

Insurance Verification: The Non-Negotiable Step That Drives Your Medical Practice’s Cash Flow In a medical practice, few tasks are as crucial—or as complex—as insurance verification. This essential step is the bedrock of a healthy revenue cycle management strategy, directly impacting your practice’s financial stability and, critically, your patients’ experience. Performing accurate and timely patient eligibility

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Learn Spravato Coding & Reimbursement Now!

Learn Spravato Coding & Reimbursement Now! Navigating the coverage and reimbursement landscape for SPRAVATO® (esketamine) nasal spray requires careful consideration to ensure compliance and optimize reimbursement. The assignment of a Healthcare Common Procedure Coding System (HCPCS) code and a payment rate does not guarantee coverage by Medicare, Medicaid, or private payers. Each payer determines whether

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Why Ensuring Payer Contracting for Buy-and-Bill Is Essential Before Implementing Spravato® in Your Practice

Why Ensuring Payer Contracting for Buy-and-Bill Is Essential Before Implementing Spravato® in Your Practice Before adopting the buy-and-bill model for Spravato® (esketamine) nasal spray in your practice, it’s crucial to confirm that the payers in your network are contracted to support this billing method. This step ensures financial sustainability, smooth reimbursement, and optimal patient care.

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Understanding the Differences Between Buy-and-Bill and Assignment of Benefits for Spravato® (Esketamine)

Understanding the Differences Between Buy-and-Bill and Assignment of Benefits for Spravato® (Esketamine) Spravato® (esketamine) nasal spray is a groundbreaking treatment for treatment-resistant depression (TRD) and major depressive disorder (MDD) with acute suicidal ideation or behavior. As its use grows, healthcare providers and patients must navigate different payment models to access the medication. Two common billing

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Leveraging AI to Streamline Spravato Prior Authorization for Clinicians

Leveraging AI to Streamline Spravato Prior Authorization for Clinicians The introduction of Spravato (esketamine) as a groundbreaking treatment for treatment-resistant depression has provided new hope for patients who have not responded to conventional therapies. However, obtaining prior authorization (PA) for Spravato can be a time-intensive process for clinicians, often requiring extensive documentation and coordination with

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Mental Health Copay Exemptions for Eligible Veterans

Mental Health Copay Exemptions for Eligible Veterans The Department of Veterans Affairs (VA) is committed to ensuring that veterans have access to essential mental health care services. To support this commitment, eligible veterans may be entitled to a valuable benefit—a copay exemption for their first three outpatient mental health or substance use disorder visits in

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UHC Portal Security: Users Must Verify Phone Numbers and Update One Healthcare ID

UHC Portal Security: Users Must Verify Phone Numbers and Update One Healthcare ID The landscape of healthcare is continuously evolving, with digital advancements playing a pivotal role in enhancing the efficiency and effectiveness of healthcare delivery. One such advancement is the UHC Provider Portal, a crucial tool for healthcare providers that simplifies and secures access

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Compliance with QMB Billing Rules and Guidance on Navigating Billing Procedures for QMB Patients

Compliance with QMB Billing Rules and Guidance on Navigating Billing Procedures for QMB Patients The Qualified Medicare Beneficiary (QMB) program, which offers Medicaid coverage for Medicare Part A and Part B premiums and cost-sharing to low-income Medicare beneficiaries, can be difficult to understand. The following points help clarify billing rules for healthcare providers regarding QMB

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Spravato Billing Alert: Navigating the 2026 Shift from S0013 to J0013

Insurance Verification: The Non-Negotiable Step That Drives Your Medical Practice’s Cash Flow

Learn Spravato Coding & Reimbursement Now!

Why Ensuring Payer Contracting for Buy-and-Bill Is Essential Before Implementing Spravato® in Your Practice

Understanding the Differences Between Buy-and-Bill and Assignment of Benefits for Spravato® (Esketamine)

Leveraging AI to Streamline Spravato Prior Authorization for Clinicians

Mental Health Copay Exemptions for Eligible Veterans

UHC Portal Security: Users Must Verify Phone Numbers and Update One Healthcare ID

Compliance with QMB Billing Rules and Guidance on Navigating Billing Procedures for QMB Patients

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