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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The Insurer Prior Authorization Pledge, One Year In: What Actually Changed
A year after more than 50 health plans pledged to cut prior authorization, the industry reports an 11 percent reduction, UnitedHealthcare has promised much larger cuts, and the CMS rule now sets deadlines for government plans. Here is what changed in practice, what did not, and what to watch for January 1, 2027.
MedPAC's June 2026 Report: How Medicare Checks Your Claims, in Its Own Words
MedPAC's June 2026 Report to the Congress, released June 15, includes a plain description of how Medicare pays and polices claims: MAC edits, NCCI, CERT, RACs, the SMRC and prior authorization. Here is what the chapter says, the numbers in it, and what a practice should take from them.
AMA 2026 Annual Meeting: The New Prior Authorization Policy on AI Denials
At its Annual Meeting in Chicago, June 5 to 10, 2026, the AMA House of Delegates adopted policy pushing for AI-informed coverage denials to be reviewable by a licensed physician in the same specialty. Here is what was adopted, what it does and does not change, and how to use it in appeals today.
CMS Publishes the Medicaid Work Requirement Rule: What Practices Should Prepare
On June 1, 2026 CMS released the interim final rule implementing Medicaid community engagement requirements for expansion adults, due in every affected state by January 1, 2027. What the rule requires, who is exempt, how coverage will be lost, and what a practice's front desk and billing team should change first.
UnitedHealthcare to Drop Prior Authorization for About 30 Percent of Services
On May 5, 2026 UnitedHealthcare said it will eliminate prior authorization for roughly 30 percent of the services that still require it, by the end of the year. Three weeks on, here is what the announcement does and does not say, what to check when the code lists post, and how to avoid the denials that follow.
AMA Prior Authorization Survey, May 2026: 13 Hours a Week and How to Count Yours
The AMA released its latest prior authorization physician survey on May 13, 2026: 13 hours of physician and staff time a week, 40 percent of practices with dedicated staff, and only a third of physicians expecting the insurer pledge to help. We explain the findings and how to measure your own practice's burden.
FY 2027 IPPS Proposed Rule of April 10, 2026: What It Means for Office Practices
CMS released the fiscal year 2027 inpatient hospital payment proposal on April 10, 2026, with comments due June 9. Most of it does not touch a physician office, but the mandatory nationwide joint replacement model, the quality measure changes and the payment update all reach practices that admit, round or refer.
CMS Finalizes 2027 Medicare Advantage Rates: What Practices Should Take From It
On April 6, 2026 CMS released the CY 2027 Medicare Advantage Rate Announcement: a 2.48 percent net payment increase, up sharply from the 0.09 percent advance notice, and a decision to exclude diagnoses from audio-only visits and unlinked chart reviews from risk adjustment. What it means for practices.
The April 2026 HCPCS Quarterly Update: New J Codes and What to Load
The April 1, 2026 HCPCS Level II update added new permanent codes for several injectable drugs, reinstated J1572 retroactive to January 1 and discontinued three L codes without a crosswalk. Here is what practices that bill drugs and DME should load, and how to handle first-quarter claims.
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