Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Stark Law and Anti-Kickback Statute for Practice Owners: What Needs a Lawyer
Most independent practices trip over Stark and the Anti-Kickback Statute in ordinary arrangements: a lease with a lab, a medical director stipend, a free interface, a waived copay. We explain what each law covers, which everyday deals are the risky ones, and when to stop and call counsel.
OSF Healthcare $552,250 Settlement: HIPAA Breach Notification Deadlines Matter
On July 29, 2026, OCR announced a $552,250 settlement with OSF Healthcare System over a 2021 ransomware attack affecting 53,907 people. The findings were a missing risk analysis and late breach notifications. We explain the timeline, the notification deadlines and what a small practice should check.
Cloned Documentation: What Auditors Flag and How to Configure the EHR
Copy-forward makes a note faster to write and easier to lose an audit with. We describe how reviewers identify cloned documentation, the patterns that turn a 99214 into a 99212 on review, what the OIG and CMS have said, and the EHR settings, policy and monthly audit that keep the convenience without the exposure.
The WISeR Model at Six Months: What Practices in the Six States Have Learned
Original Medicare has required prior authorization for skin substitutes, epidural injections, cervical fusion and other services in six states since January 2026. Six months in, the practices doing well share a few habits: one owner for the tracking number, a 120-day watch list and a standard packet.
Medical Records Retention: How Long to Keep Charts, Claims and Remits, by Rule
Practices keep everything forever because nobody knows which rule applies, and then a storage unit or an old server becomes the breach. We sort out the retention clocks that apply to a physician practice, HIPAA, state law, Medicare Advantage, OSHA and payer contracts, and describe how to destroy records properly.
HIPAA Right of Access: Record Fees, the 30-Day Clock and Portal Requests
Patients asking for their own records are the one HIPAA request a practice cannot slow-walk or price freely. We lay out the 30-day clock and its single extension, what a cost-based fee actually includes, how attorney requests differ, and how to run the process so a complaint never reaches OCR.
Qualified Medicare Beneficiary Billing Rules: Spot QMB Status, Refund Mistakes
Federal law bars practices from billing Qualified Medicare Beneficiaries for Medicare deductibles, coinsurance and copays, yet statements still go out to them. We explain how QMB works, where the status shows up on eligibility and remits, how to post the balance, and how to refund what was collected in error.
OIG Exclusion Screening for a Medical Practice: Monthly Checks, What a Hit Means
OIG exclusion screening means checking every employee and vendor against the LEIE and your state Medicaid list every month. Here is who to screen, how to run the check so it holds up, what a match actually costs, and the steps to take in the first week after a hit.
Mid-Year 2026 Breach Review: Clearinghouses and Vendors Are the Weak Point
Through May, the largest healthcare breaches of 2026 have hit a clearinghouse, a dermatology management company, a hospital and a benefits administrator, with more than 21 million people affected. What the first half shows, why business associates dominate the list, and the vendor questions every practice should ask.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.