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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
ACA Insurers Propose a 14% Median Premium Increase for 2027: Practice Impact
KFF's July 8 analysis of 77 Marketplace insurers in 16 states and DC found a median proposed premium increase of 14 percent for 2027, the second straight year of double-digit requests. For practices that means plan switching, higher deductibles and self-pay conversions in January. Here is how to prepare.
HIPAA Right of Access: Record Fees, the 30-Day Clock and Portal Requests
Patients asking for their own records are the one HIPAA request a practice cannot slow-walk or price freely. We lay out the 30-day clock and its single extension, what a cost-based fee actually includes, how attorney requests differ, and how to run the process so a complaint never reaches OCR.
Workers' Compensation Billing for Practices: Authorization, Fee Schedules, Forms
Workers' compensation claims follow state rules, not payer contracts, and most billing teams learn them by losing money. We cover what to capture before the first visit, how state fee schedules and filing limits work, the reports that must ride with every bill, and the denials that follow when they do not.
A 90-Day Plan for the October 1, 2026 ICD-10-CM Update: 190 New Codes
CMS and the CDC posted the FY 2027 ICD-10-CM files on June 5, 2026: 190 new codes, 30 deletions and four revised titles, effective for dates of service on or after October 1, 2026. It is a quieter year than FY 2026, which is exactly when practices get sloppy. Here is a week-by-week plan from July 7 to October 1.
Wound Care and Debridement Coding: 97597, 11042 to 11047, Depth and Surface Area
Debridement claims fail on two questions: how deep did you go, and how many square centimeters did you debride? We explain the difference between 97597 and the 11042 to 11047 series, how to add up surface area across wounds, what the note must record, and a worked example with three wounds at two depths.
Injection and Infusion Coding Hierarchy: 96360 to 96379, Initial vs Subsequent
Office infusions are small dollars per visit and large dollars per year, and they are coded wrong more often than any other office procedure we audit. We walk through the 96360 to 96379 family, the one-initial-code rule, the hydration time rules and a worked example with start and stop times.
Qualified Medicare Beneficiary Billing Rules: Spot QMB Status, Refund Mistakes
Federal law bars practices from billing Qualified Medicare Beneficiaries for Medicare deductibles, coinsurance and copays, yet statements still go out to them. We explain how QMB works, where the status shows up on eligibility and remits, how to post the balance, and how to refund what was collected in error.
CY 2027 OPPS and ASC Proposed Rule: What Office Practices Should Read
CMS released the CY 2027 hospital outpatient and ASC proposed rule on July 2, 2026. Most of it is written for hospitals, but the botulinum toxin prior authorization expansion, site-neutral imaging and the inpatient-only list phase-out reach physician practices. Here is what to read and what to skip.
UnitedHealthcare July 2026 Policy Updates: What Your Practice Should Check
UnitedHealthcare posted its July 2026 monthly overview and policy bulletins on July 1. Most items are quarterly code housekeeping, but a DME process change in eleven states, three prior authorization changes with fall dates and several state Medicaid items deserve a look now.
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