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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CY 2027 Physician Fee Schedule Proposal: Comments Closed, What to Budget For
CMS proposed a 2027 conversion factor of $32.84 for most physicians, a 1.68 percent cut from 2026, plus a new payment reduction for E/M visits on the day of a global procedure. Comments closed September 14. Here is what the proposal means for a practice budget and what to watch for in the final rule.
Flu Shot Billing for 2026 to 2027: G0008, Vaccine Codes and Payer Rules
CMS has posted the Medicare Part B payment allowances for 2026 to 2027 influenza vaccines, effective August 1, and clinics are stocked. Here is how we set up flu shot billing for the season: G0008 versus 90471, the product codes, Z23, Medicare Advantage routing, roster billing and the October denials.
Physical Therapy Billing in a Physician Practice: Units, KX and Plan of Care
Adding a physical therapist to an orthopedic or primary care practice adds a billing rulebook nobody on the staff has read. Here is how physical therapy billing in a physician practice works: counting timed units under the 8-minute rule, the 2026 KX threshold, plan of care certification and the PTA modifier.
Principal Care Management 99424 to 99427: How It Differs From CCM, Who Bills It
Principal care management pays a specialist for the between-visit work of managing one serious condition, and most specialty practices never bill it. Here is what 99424 to 99427 require, how the time rules differ from chronic care management, and the documentation that survives an audit.
What Practices Should Review Before Outsourcing Medical Billing
Outsourcing billing changes who does the work, not who is responsible for the revenue. Here is what to examine in your own practice first, the questions that separate a billing company from a claim-submission service, and what the agreement must say.
FDA Approves 2026-2027 COVID-19 Vaccines: What Practices Set Up Before Billing
On August 27, 2026 the FDA approved four updated COVID-19 vaccines for the 2026-2027 season, targeting the XFG variant and limited to adults 65 and older and younger people with risk conditions. What that means for eligibility screening, vaccine codes and CMS pricing, administration billing and the front desk.
Chronic Pain Management Codes G3002 and G3003: Requirements and Monthly Billing
Medicare has paid for a monthly chronic pain management bundle since 2023, and most primary care practices still do not bill it. We explain who qualifies, what G3002 and G3003 require in the first visit and every month after, how the 30-minute rule works, and how the codes fit with CCM and PCM.
How to Bill Home Health Certification: G0180, G0179, G0181 and the Face-to-Face
Signing a stack of home health plans of care is billable work that most primary care offices give away. We explain when G0180 and G0179 apply, what the face-to-face encounter must show, how to count the 30 minutes behind G0181, and the documentation that survives a Medicare review.
The G2211 Modifier and the 50% Same-Day E/M Cut: Modeling the CY 2027 Proposal
Two proposals in the July 14 physician fee schedule rule move money in opposite directions. A 16 percent G2211 modifier helps high-level visit mixes and hurts low-level ones. Paying same-day E/M visits with globals at 50 percent hurts anyone doing office procedures. Here are the numbers, worked through.
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