Anwaar Tayyab
Anwaar Tayyab is Director of Billing Operations at US Medical Billing, and the named reviewer of the guidance published on this site.
Updated
Director of Billing Operations
US Medical Billing
Anwaar Tayyab is Director of Billing Operations at US Medical Billing. He has worked in medical billing for five years, across claims, denials and payer enrolment for physician practices. He reviews the guidance published on this site.
Guidance reviewed
246 articles in the Knowledge Base carry a review date, across 11 categories. Each one is listed because its own record carries the review date — this list is derived from the articles, never kept beside them.
Revenue Cycle Management24
- What Is Revenue Cycle Management (RCM)?
- The Stages of the Revenue Cycle, in Depth
- Revenue Cycle KPIs: Reading the Metrics Together
- In-House vs. Outsourced RCM: A Decision Framework
- Revenue Cycle Governance: Ownership and Decision Rights
- Building a Revenue Cycle Operating Model
- Mapping Work from Patient Access to Final Balance
- Revenue Cycle Handoffs and Control Points
- Designing a Revenue Cycle Policy Library
- Building a Revenue Cycle Issue Escalation Path
- Revenue Cycle Data Definitions and Metric Governance
- Creating a Revenue Cycle Meeting Cadence
- Documenting Revenue Cycle Standard Operating Procedures
- Revenue Cycle Change Management
- Separating Work Queues from Reporting Views
- Revenue Cycle Roles and Accountability
- Building a Revenue Cycle Risk Register
- Revenue Cycle Process Mapping
- Managing Revenue Cycle Exceptions
- Establishing Revenue Cycle Service Levels
- Revenue Cycle Root-Cause Analysis
- Revenue Cycle Quality Assurance
- Revenue Cycle Business Continuity Planning
- Evaluating Revenue Cycle Technology Changes
Claims27
- From Encounter to Billable Charge
- Building a Charge Capture Workflow
- Charge Entry Validation Before Claim Creation
- The Data Elements That Make a Professional Claim
- CMS-1500 and 837P: Paper Form and Electronic Transaction
- Professional and Institutional Claims: Operational Differences
- Claim Creation Controls Before Transmission
- How Claim Batches Are Prepared and Released
- Pre-Submission Claim Validation
- Reading Claim Submission Acknowledgments
- Using Clearinghouse Submission Reports
- Corrected, Replacement, and Void Claims
- Preserving Timely Filing Evidence
- When a Claim Needs an Attachment
- The Coding-to-Billing Handoff
- Billing, Rendering, and Referring Provider Identifiers
- Place of Service on Professional Claims
- Claim-Level and Line-Level Information
- Documenting Claim Corrections
- Closing the Claim Submission Batch
- Reading a Payer Companion Guide
- What Is a Medical Claim?
- The Claim Lifecycle: The Four Gates a Claim Passes
- What Makes a Claim Clean
- Submitting Claims: Routing and the Acknowledgment Chain
- Tracking a Claim: Status, Aging, and Follow-Up
- Medical Billing vs. Medical Coding
Denials & Appeals25
- What Is a Claim Denial?
- Why Claims Get Denied
- Reading a Denial: Codes, Group Codes, and the Remittance
- Appealing a Denial: When, What, and How Long You Have
- Preventing Denials: The Controls That Work Upstream
- The Levels of Appeal: Where a Denial Goes Next
- Who Can Appeal a Denial: Standing, Assignment, and Representation
- Duplicate Claim Denials: True Duplicate or Distinct Service?
- Timely Filing Denials: Which Deadline Applied, and When There's an Exception
- Medical Necessity Denials: The Coverage Policy, Not the Care
- Coordination of Benefits Denials: When the Payer Thinks Another Plan Is Primary
- Non-Covered Service Denials: When the Plan Never Covered It
- Experimental or Investigational Denials: When the Payer Calls It Unproven
- Place of Service Denials: When the Setting Doesn't Match the Claim
- Partial Denials: When Part of a Claim Pays and Part Is Denied
- Secondary Claim Denials: When the Second Plan Denies on Its Own Terms
- Corrected Claim Denied Again: Why the Resubmission Failed
- Billing the Patient for a Denied Claim: When You May and When You May Not
- Payer Medical Policy: How to Find and Read a Coverage Policy
- Prioritizing Denial Work: Which Denials to Work First
- Denial Reporting by Payer
- The Appeal Letter: What the Document Has to Contain
- Post-Service Peer-to-Peer Review: The Reviewer Call After a Denial
- Denial Write-Off Policy: Deciding When a Denied Balance Is Written Off
- Appeal Tracking and Follow-Up: Carrying a Filed Appeal to Resolution
Payments & Posting25
- From Billed Charge to Collected Dollar
- How Payment Posting Works
- Payment Reconciliation: Proving the Cash
- Secondary Billing and Coordination of Benefits
- Patient Responsibility: Deductibles, Copays, and Coinsurance
- Underpayments and Overpayments
- EOB vs. ERA
- How to Read an 835
- ERA and EFT Enrollment
- EFT and ERA Reassociation
- Contractual Adjustment vs. Write-Off
- Refunding a Credit Balance
- Unapplied Cash
- Lockbox Reconciliation
- Posting Patient Payments
- Posting Capitation Payments
- Posting a Payer Interest Payment
- Posting a Payer Offset
- Zero-Balance Review
- Validating Contractual Adjustments
- Auto-Posting Rules
- Payment Posting Errors
- Cash Application Controls
- Patient Refunds and Unclaimed Property
- The Month-End Cash Close
Credentialing20
- Credentialing vs. Enrollment
- Enrollment Pathways: Medicare, Commercial, Individual, Group
- Effective Dates: When a Provider Can Actually Bill
- Enrollment Maintenance: The Records That Lapse
- What is provider credentialing?
- Credentialing vs. privileging
- Primary source verification explained
- The CAQH profile
- Building a credentialing file
- The payer enrollment application
- Individual vs. group enrollment
- Medicare enrollment with PECOS
- The CMS-855 application family
- Medicaid provider enrollment
- Commercial payer contracting
- Credentialing timelines and planning
- Revalidation and recredentialing
- Maintaining CAQH and attestation
- Delegated credentialing
- Credentialing gaps and enrollment-related denials
Eligibility verification20
- What Is Eligibility Verification?
- Eligibility vs. Benefit Verification
- How Electronic Eligibility Checks Work
- Reading an Eligibility Response
- Estimating Patient Cost-Share Before Service
- Real-Time vs. Batch Eligibility
- Confirming Active Coverage and Effective Dates
- Identifying Primary and Secondary Coverage
- Verifying Network Status and Plan Type
- Verifying Medicare Eligibility
- Verifying Medicaid Eligibility
- Eligibility-Related Denials and Their Causes
- Building a Front-Desk Eligibility Workflow
- Eligibility Checks for Telehealth
- Referral Requirements and Eligibility
- Verifying Secondary and Tertiary Coverage
- Registration Data Quality and Eligibility
- Re-Verifying Recurring Patients
- Measuring Eligibility Verification Performance
- Eligibility Verification Tools and Automation
Prior authorization20
- What is prior authorization?
- Prior authorization vs. referral
- Precertification, predetermination, and prior authorization
- Which services require prior authorization
- The prior authorization workflow
- Gathering clinical documentation for authorization
- Submitting a prior authorization request
- Tracking authorization status and deadlines
- Approvals, denials, and peer-to-peer review
- Retroactive and urgent authorizations
- Authorization-related denials
- Matching authorized units to billed services
- Prior authorization for medications
- Prior authorization under Medicare Advantage
- Prior authorization under Medicaid
- The CMS Interoperability and Prior Authorization rule
- Electronic prior authorization
- Building a prior authorization tracking process
- Measuring prior authorization performance
- Reducing authorization-related write-offs
Medicare billing20
- How Medicare is structured (Parts A, B, C, D)
- Medicare Part A billing
- Medicare Part B billing
- Medicare Advantage (Part C) billing
- The Medicare Beneficiary Identifier (MBI)
- Medicare Administrative Contractors (MACs)
- Medicare fee schedules explained
- Assignment and participation
- The Advance Beneficiary Notice (ABN)
- Medicare Secondary Payer (MSP) billing
- National and local coverage determinations
- Medicare timely filing
- Medicare Part B drugs and biologicals
- Medicare telehealth billing
- Medicare preventive services billing
- Incident-to and split/shared billing
- Medicare enrollment and billing privileges
- Medicare overpayments and recoupment
- Reading the Medicare remittance and MSN
- Common Medicare billing denials
Medicaid billing20
- How Medicaid works
- Medicaid vs. Medicare
- Fee-for-service vs. managed Medicaid
- Medicaid managed care organizations
- Medicaid eligibility categories
- Verifying Medicaid coverage
- Medicaid provider enrollment basics
- The federal-state structure of Medicaid
- Medicaid fee schedules and reimbursement
- Medicaid as payer of last resort
- Medicaid timely filing
- Medicaid prior authorization
- Dual-eligible beneficiaries
- Medicaid crossover claims
- EPSDT billing
- Medicaid and CHIP
- Medicaid third-party liability
- Medicaid claim submission basics
- Common Medicaid billing denials
- State Medicaid program variation
Behavioral health billing20
- Behavioral health billing overview
- Behavioral health code families
- Psychotherapy time-based billing
- Evaluation and management in behavioral health
- Behavioral health place of service and telehealth
- Billing for group therapy
- Billing for medication management
- Substance use disorder billing
- Medication-assisted treatment billing
- Behavioral health parity
- Behavioral health prior authorization
- Behavioral health eligibility and carve-outs
- Collaborative care model billing
- Behavioral health documentation requirements
- Billing intensive outpatient and PHP
- Behavioral health under Medicaid
- Behavioral health under Medicare
- Confidentiality and 42 CFR Part 2
- Common behavioral health denials
- Measuring the behavioral health revenue cycle
Compliance and Regulations25
All Compliance and Regulations
- What Is the No Surprises Act
- Good Faith Estimates for Self-Pay Patients
- Hospital Price Transparency
- The HIPAA Privacy Rule in Medical Billing
- Applying the Minimum Necessary Standard in Medical Billing
- Business Associate Agreements in Medical Billing
- The HIPAA Security Rule in Medical Billing
- The HIPAA Breach Notification Rule in Medical Billing
- The HIPAA Right of Access in Medical Billing
- The Seven Elements of an Effective Compliance Program
- OIG Exclusion Screening in Medical Billing
- The Anti-Kickback Statute in Medical Billing
- The Stark Law and Physician Self-Referral in Medical Billing
- Waiving a Patient's Copay, Coinsurance, or Deductible
- The 60-Day Overpayment Rule
- The OIG Self-Disclosure Protocol
- The Types of Medicare Audits
- Responding to a Payer's Request for Medical Records
- Medical Records Retention
- The Information Blocking Rule
- The No Surprises Act Independent Dispute Resolution Process
- The No Surprises Act Notice and Consent Exception
- The Transparency in Coverage Rule
- The False Claims Act in Medical Billing
- Running an Internal Billing Audit