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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Credentialing Terms Explained: CAQH, PECOS, NPPES, Delegation, Effective Dates
Credentialing has its own vocabulary, and a physician who does not know it cannot tell whether a delay is normal or a problem. This glossary explains the thirty terms that come up in every enrollment, from NPPES and PECOS to primary source verification, delegated credentialing and retroactive effective dates.
AMA 2026 Annual Meeting: The New Prior Authorization Policy on AI Denials
At its Annual Meeting in Chicago, June 5 to 10, 2026, the AMA House of Delegates adopted policy pushing for AI-informed coverage denials to be reviewable by a licensed physician in the same specialty. Here is what was adopted, what it does and does not change, and how to use it in appeals today.
FY 2027 ICD-10-CM Update: 190 New Codes Take Effect October 1, 2026
The FY 2027 ICD-10-CM files are posted: 190 new billable codes, 4 revised, and about 30 that lose billable status, effective for dates of service on or after October 1, 2026. Here is what changed by specialty, the codes most practices will actually use, and the September checklist for your EHR and payer edits.
Responding to a Medicare Targeted Probe and Educate Review: The Three Rounds
A Targeted Probe and Educate letter from your Medicare contractor starts a process with up to three rounds of 20 to 40 claims, an education session after each, and a referral to CMS if you fail all three. Here is how the rounds work, what the error rate means, and how to close the review out in round one.
Run Your Coding Audit Now, Before the October 1, 2026 Diagnosis Code Update
A coding audit in June gives you three months to fix habits before the FY 2027 ICD-10-CM codes take effect on October 1. Here is the sample design we use, the six error types that account for most findings, a worked scoring example, how to read an E/M level distribution, and what to do with the results.
Skin Lesion Removal Coding in Primary Care: Excision, Destruction and Pathology
Skin lesion removal coding turns on three decisions: excision or destruction, the measured size including margins, and what pathology says. Here is how to pick the code family, measure before the cut, hold the claim for the path report and avoid the denials that follow a wrong diagnosis code.
Revenue Cycle KPIs Explained for Physicians: Clean Claim Rate, Days in AR, More
Most practice owners get a monthly report full of revenue cycle KPIs and trust none of them. This glossary explains the ten that matter, gives the formula for each, the commonly quoted benchmark, the way each one gets gamed, and a worked example from a four-provider practice.
MIPS 2024 Data Preview Closes June 11, 2026; PI Window Must Start by July 5
Two MIPS dates land in the next five weeks. Physicians can preview their 2024 MIPS performance data before it is posted on Medicare.gov compare until June 11, 2026, and the 2026 Promoting Interoperability 180-day window must begin by July 5. Here is what to check in each.
The CMS ACCESS Model Starts July 5, 2026: Should Your Practice Look at It?
The Innovation Center's ACCESS model begins its ten-year run on July 5, paying participating organizations outcome-aligned payments for chronic condition tracks instead of fee-for-service. Here is how the payment works, the fee-for-service exclusion most summaries skip, and the questions to answer first.
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