Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
PCMH Annual Reporting: A Mid-Year Check and NCQA's Proposed 2027 Changes
Recognized practices report to NCQA once a year, and the ones that struggle are the ones that start in the month it is due. Here is the June check we recommend, the evidence that takes longest to assemble, a worked care management example, and what NCQA proposed this spring for the Care Management criteria in 2027.
Missed Charges in Office Procedures: Injections, Vaccines and the Audit
The visit is billed and the procedure is not. Injection administration without the drug, vaccines without the administration code, drug units under-counted, point-of-care tests never charged. Here is where missed charges hide in office practice, a code-by-code table, and a two-hour audit that finds them.
ERA and EFT Enrollment: Why Paper Remits and Virtual Cards Cost You Money
Electronic remittance advice and electronic funds transfer are standard HIPAA transactions every health plan must offer, yet many practices still post paper EOBs and accept virtual cards with fees attached. How enrollment works payer by payer, what the 835 does for posting, and what the fees cost.
OIG Exclusion Screening for a Medical Practice: Monthly Checks, What a Hit Means
OIG exclusion screening means checking every employee and vendor against the LEIE and your state Medicaid list every month. Here is who to screen, how to run the check so it holds up, what a match actually costs, and the steps to take in the first week after a hit.
Mid-Year 2026 Breach Review: Clearinghouses and Vendors Are the Weak Point
Through May, the largest healthcare breaches of 2026 have hit a clearinghouse, a dermatology management company, a hospital and a benefits administrator, with more than 21 million people affected. What the first half shows, why business associates dominate the list, and the vendor questions every practice should ask.
Writing a Patient Financial Policy: The Nine Clauses and the Words to Use
A patient financial policy is the document your front desk points to when a patient objects to paying. Most are either two vague paragraphs or four pages nobody reads. Here are the nine clauses a policy needs, sample wording for each, the legal lines not to cross, and how to roll it out without a fight.
The Prior Authorization Metrics Payers Now Publish, and How to Use Them
Since January 1, 2026, Medicare Advantage, Medicaid managed care and Exchange plans must decide standard authorizations in seven days, give a specific denial reason, and publish annual authorization metrics. Where to find the reports, what they show, a worked comparison of two plans, and three ways to use them.
MedPAC's June 2026 Report: How Medicare Checks Your Claims, in Its Own Words
MedPAC's June 2026 Report to the Congress, released June 15, includes a plain description of how Medicare pays and polices claims: MAC edits, NCCI, CERT, RACs, the SMRC and prior authorization. Here is what the chapter says, the numbers in it, and what a practice should take from them.
How to Prepare for a Peer-to-Peer Review: Scripts, Evidence and Timing That Work
A peer-to-peer review is often the last chance to overturn a prior authorization denial before a formal appeal, and most practices walk in unprepared. Here is how to schedule it, what the physician should have on the desk, a five-minute script, and how to document the call so the outcome sticks.
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