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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
July 2026 NCCI Edits and HCPCS Update: What to Load Before Your Next Claim Run
The third-quarter code update took effect July 1, 2026: a new HCPCS Level II file, practitioner NCCI edits version 322 and the Q3 add-on code edits. Here is what changed in the cycle, where each file lives, and the order in which we load and test them.
State Prompt Pay Laws: The Clean Claim Clock and How to Collect the Interest
Almost every state gives a payer 30 to 45 days to pay a clean claim and charges interest when it is late, but the interest rarely arrives on its own. Here is how the clean claim clock works, what Texas, New York, California and Florida require, which plans are exempt, and how to bill the payer for what it owes.
Medicaid Provider Tax Changes on June 30 and October 1, 2026: What They Mean
Two dates this year begin the unwinding of Medicaid provider taxes under last year's budget law: non-uniform managed care tax arrangements end with most state fiscal years on June 30, and provider tax rates are frozen from October 1. What the law does, the phase-down that follows, and why practices should care.
A Patient Experience Survey for PCMH: Questions, Sample Size and What to Change
NCQA expects a recognized medical home to survey patients across at least three dimensions and act on the results. Here is how to build a patient experience survey for PCMH: which CAHPS-style questions to ask, how many responses you need, how to score them and how to turn a low score into a change.
Teaching Physician Billing Rules in a Private Practice: GC, GE and Being Present
When residents rotate through a private practice, Medicare pays the teaching physician only if the presence and documentation rules are met. Here is what "present for the key portion" means, when modifiers GC and GE apply, how the primary care exception works and what changed on January 1, 2026.
Loading Your 2026 Fee Schedules to Catch Underpayments Before Year-End
You cannot find an underpayment without knowing what the correct payment was. Half of 2026 has been paid at rates most practices never loaded. Here is how to load Medicare's two 2026 conversion factors and your commercial contracts, run a variance report, and recover what payers owe before the contract year closes.
Pre-Service Financial Clearance for Procedures: Verify, Estimate, Collect
Pre-service financial clearance means knowing, before the patient arrives for a procedure, that coverage is active, authorization is in hand and the patient knows what they owe. Here is the timeline, the benefit fields to read, a worked estimate and the script that collects it.
The Insurer Prior Authorization Pledge, One Year In: What Actually Changed
A year after more than 50 health plans pledged to cut prior authorization, the industry reports an 11 percent reduction, UnitedHealthcare has promised much larger cuts, and the CMS rule now sets deadlines for government plans. Here is what changed in practice, what did not, and what to watch for January 1, 2027.
Teaching E/M Leveling to New Coders: 99213 vs 99214 Under MDM, With Examples
The 99213 versus 99214 decision is made a hundred times a day in every office practice, and new coders learn it badly from memorized bullet points. Here is how we teach it: the three MDM elements, the definitions that actually decide the level, six worked cases, and the mistakes that show up in audits.
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