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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Payer 1099 Reconciliation: Matching January Tax Forms to Posted Payments
Every payer that paid your practice more than $600 last year mails a 1099 in January. Most practices hand the envelope to the accountant. We think the billing office should open it first, because the gap between the 1099 total and what you posted is a map to missing money.
Re-Verifying Patients Who Lost Marketplace Subsidies: A January Workflow
The enhanced premium tax credits expired on December 31, 2025, and many marketplace patients arrived in January with a new plan, a new network or a grace-period notice. Here is how to re-verify every marketplace patient and avoid the retroactive termination denials that follow.
How to Calculate Days in AR and What the Number Actually Tells You
Days in accounts receivable is the most quoted billing metric and the most misread. Here is the formula, the two ways practices distort it, the ranges we see for independent practices by specialty, and how to split it by payer and aging bucket so it points at something you can fix.
Fee Schedules and CPT 2026: What to Load and Test Before the First January Claim
CPT 2026 takes effect January 1 with 288 new codes, 84 deletions and 46 revisions. The Medicare conversion factor, the corrected skin substitute rate, the OPPS update and the 2026 Part B deductible all change the same day. Here is the December checklist we run so the first January claims go out clean.
A 90-Day Plan Before the October 1 ICD-10-CM Update (487 New Codes)
The FY 2026 ICD-10-CM update takes effect October 1, 2025 with 487 new codes, 38 revisions and 28 deletions. The practices that lose money on code updates are the ones that start in September. Here is a week-by-week plan starting now.
Medicaid Eligibility Checks After the Unwinding: What Still Goes Wrong
The Medicaid unwinding is over, but the churn it created is not. Over 25 million people were disenrolled, most for paperwork reasons, and many came back under a different managed care plan. Here is how eligibility for Medicaid patients actually fails at the front desk in 2025 and the checks that catch it.
Building a Monthly RCM Scorecard: The Twelve Numbers and Where to Pull Them
A monthly revenue cycle scorecard is one page, twelve numbers, the same definitions every month, and a name next to each. Here is the list we use, the formula for each, where the data comes from, the ranges that suggest a problem, a sample page, and the mistakes that make scorecards useless.
How to Prepare a Charge Master for the October and January Code Changes
Two code updates hit within 90 days: ICD-10-CM on October 1 and CPT and HCPCS on January 1. Here is the step-by-step process we use to update fee schedules, superbills, charge rules and EHR favorites so the first claims of each period don't reject, with a worked example and the mistakes that repeat every year.
MIPS 2024 Mid-Year Checkpoint: What to Review Before the Second Half of the Year
The 2024 MIPS performance year is half over, the threshold to avoid a penalty is 75 points, and the penalty for missing it is up to 9% of 2026 Medicare Part B payments. Here is the review to finish in July: eligibility, the 180-day Promoting Interoperability window, quality data and the mistakes that cost points.
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