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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Underpayments Hiding in First-Quarter Remits: The Fee Schedule Variance Check
Payers loaded new fee schedules in January, and some of them loaded the wrong one. A denial shows up in a report; an underpayment posts as paid and disappears. Here is the quarterly variance check we run: which contracts to load, how to reprice a sample, which reductions are legitimate, and how to get a systematic fix.
Hospital Charge Capture for Office-Based Physicians Who Round: Closing the Gap
Physicians who see patients in the hospital and bill from the office lose charges in the hand-off between the two buildings. We show where hospital charge capture for physicians breaks, how to reconcile the hospital census against billed encounters and the weekly routine that closes the gap.
Billing 99211 Nurse Visits Correctly: What Qualifies and What Gets Missed
Nurse visits are either billed for things that don't qualify or never billed at all. Here is what billing 99211 nurse visits correctly requires: an actual evaluation and management service, Medicare's incident-to supervision rules, the services 99211 can never be billed with, and the charges practices forget.
JW and JZ Modifiers: Drug Wastage Billing and the Drug Charges Practices Miss
Since October 2023 Medicare returns single-dose drug claims that lack a JW or JZ modifier, and most practices fix them one rejection at a time. The rules, the billing-unit arithmetic behind most drug underpayments, a worked infusion example and the three-report audit that finds missing drug revenue.
Checking February Medicare Remits Line by Line Against the 2026 Fee Schedule
The first full month of 2026 Medicare payments is posted. With two conversion factors, an efficiency adjustment on procedures and new practice expense allocations, expected allowed amounts changed for almost every code. Here is how to build the expected amount and find the lines that paid short.
How to Bill J-Codes and Drug Units in the Office Without Losing the Charge
Every injection and infusion in an office carries two charges: the drug and the administration. Practices lose one or the other constantly. We explain how to bill J-codes and drug units, work the unit math on common drugs, cover the JW and JZ modifiers, and show where the charge falls out of the workflow.
Medical Practice Write-Off Policy: Adjustment Codes and Where Money Disappears
Every dollar a practice fails to collect leaves through an adjustment code, and most practices have one or two codes doing all the work. Here is a write-off policy that separates contractual adjustments from real losses: the codes we insist on, approval thresholds and the monthly report.
The Year-End Timely Filing Sweep: What to Run in the Last Six Weeks of the Year
Every December, practices write off claims that were still recoverable in November. Here is the timely filing sweep we run in the last six weeks of the year: the reports, the payer limits, the appeal windows, and how to handle the shutdown-era telehealth claims that are sitting in the queue.
Mid-Year Revenue Leakage Check: Six Things That Changed in January 2025
Every January brings a new conversion factor, new codes, new payer contracts and reset deductibles, and every June is the right time to check whether the practice actually caught them. Here are six leakage sources specific to the first half of 2025, the report that exposes each one, and how to size what you find.
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