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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
WISeR at Three Months: Prior Authorization in Traditional Medicare in Six States
Since January 1, 2026 the CMS WISeR model has applied prior authorization to a short list of services in traditional Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Here is how it works, what practices in those states have run into so far, and what to watch if you are elsewhere.
RADV Audits for Payment Year 2020 Began in March 2026: Expect MA Chart Requests
On March 20, 2026 CMS told Medicare Advantage organizations which contracts are selected for payment year 2020 risk adjustment audits, the first wave under the program expanded in May 2025. Plans have five months to gather records, so requests for 2019 charts are coming. What to expect and how to respond.
Medicare Telehealth Extended Through 2027: What the January 31 Lapse Means
The Medicare telehealth flexibilities lapsed on January 31 while H.R. 7148 moved between the Senate and the House. The bill extends them through December 31, 2027. Here is what was extended, what happened to claims during the gap, and what to do this week.
2027 MA Advance Notice: What the Audio-Only Change Means for Practices
CMS released the 2027 Medicare Advantage and Part D Advance Notice on January 26, 2026, proposing a nearly flat payment update and excluding diagnoses from audio-only visits and unlinked chart reviews from risk adjustment. Here is why practices, not just plans, should read it.
Medicare Telehealth Flexibilities Expire January 30, 2026: A Plan for February
The continuing resolution signed November 12, 2025 extended Medicare telehealth flexibilities only through January 30, 2026. Unless Congress acts within days, home-based and audio-only telehealth for most Medicare patients loses coverage January 31. What stops, what continues, and a February plan.
The CY 2026 Physician Fee Schedule Is Live: What Changes on Your January Remits
The 2026 Medicare fee schedule took effect January 1 with two conversion factors, a 2.5 percent efficiency adjustment on procedural work and a flat rate for skin substitutes. Here is what to check when the first remits of the year arrive.
Shutdown Over: Medicare Telehealth Is Back Through January 30. Fix the Claims
The Continuing Appropriations Act, 2026 was signed on November 12, 2025, ending the 43-day shutdown and restoring the Medicare telehealth flexibilities retroactively to October 1 and through January 30, 2026. CMS says shutdown-period claims will be paid as if the lapse never happened. Here is the cleanup list.
Shutdown Day One: Medicare Telehealth Waivers Lapse and CMS Holds the Claims
The federal government shut down on October 1, 2025 and the Medicare telehealth waivers expired with it. CMS has told the MACs to hold affected claims for ten business days. Here is what reverted, who is affected, and what to do with this week's telehealth visits.
Medicare Telehealth Flexibilities End September 30: A Plan for October Visits
With four days left, Congress has not extended the Medicare telehealth flexibilities that end September 30, 2025, and a government shutdown looks likely on October 1. Here is exactly what lapses, what stays, and how to handle the October schedule and the claims.
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