Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CY 2026 OPPS Proposed Rule: Inpatient-Only List and Site-Neutral Payment
CMS released the CY 2026 OPPS and ASC proposed rule on July 15, 2025: a 2.4 percent update, a three-year phase-out of the inpatient-only list starting with 285 procedures, and site-neutral payment for drug administration in off-campus departments. Here is what it means outside the hospital.
CY 2026 Physician Fee Schedule Proposed Rule: What Practices Should Model Now
CMS released the CY 2026 Physician Fee Schedule proposed rule on July 14, 2025. Two conversion factors, a 2.5 percent efficiency adjustment, a practice expense cut for facility-based services and a skin substitute overhaul. Here is what to model and what to comment on.
OBBBA Medicaid Changes: What Practice Eligibility Workflows Need Now
The One Big Beautiful Bill Act became law on July 4, 2025. Its Medicaid provisions arrive in stages from 2026 to 2028, but the eligibility habits that will protect a practice need to start this year. Here is what changed, when, and what to do about it.
CMS WISeR Model Brings Prior Authorization to Traditional Medicare in Six States
On June 27, 2025, the CMS Innovation Center announced the WISeR model, bringing prior authorization to a list of traditional Medicare services in six states from January 1, 2026. Here is what is covered, how the review works, and what practices in those states should do before January.
House Passes the One Big Beautiful Bill: Medicaid Changes Practices Should Track
The House passed H.R. 1 by a single vote on May 22, 2025. Its Medicaid provisions, including work requirements, six-month redeterminations and new cost sharing for expansion adults, now go to the Senate. Nothing is law yet, but the direction is clear enough that practices with Medicaid patients should start planning.
UnitedHealth's CEO Change and MA Scrutiny: What It Means for Your Practice
UnitedHealth Group replaced its chief executive on May 13, 2025, suspended its 2025 outlook and cited rising medical costs in Medicare Advantage, all amid press reports of Department of Justice investigations into MA billing. Here is what a large payer under pressure tends to do next, and how practices should prepare.
HHS Restructuring, a New Secretary and the Medicaid Budget Fight: What to Watch
In ten weeks, HHS got a new Secretary, the House passed a budget resolution that points at Medicaid, and on March 27, 2025 HHS announced a plan to cut about 20,000 positions and fold 28 divisions into 15. Here is what happened, what it does and does not change for a practice, and what to watch.
Medicare Telehealth Flexibilities Extended to September 30, 2025: What to Do Now
The full-year continuing resolution signed March 15, 2025 extends Medicare telehealth flexibilities through September 30, 2025, two weeks before they were due to lapse. Here is what was extended, what was not, the billing rules that still apply, and how to unwind the April contingency plans.
The AMA's New Prior Authorization Survey and the CMS-0057-F Clock
The AMA released its 2024 prior authorization physician survey on February 24, 2025: 93 percent of physicians report care delays and 29 percent report serious adverse events. Federal payer deadlines under CMS-0057-F start January 1, 2026. Here is what to build now.
Page 4 of 5 · 44 articles
Want this level of attention on your own revenue cycle?
The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.