Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Billing Office Standard Operating Procedures: The 12 SOPs Every Practice Needs
When the one biller who knows how things work goes on leave, the practice discovers it has no billing office standard operating procedures. We list the twelve SOPs every practice should write, the one-page format that actually gets read, who owns each one, and the triggers that keep them current instead of decorative.
How a CPT Code Gets Made: The May 2026 Panel Meeting and the CPT 2028 Cycle
The AMA posted the summary of actions from the May 2026 CPT Editorial Panel meeting on May 15, the second of three meetings that will shape the 2028 code set. We explain how the CPT code process works, what the summary tells a practice, why it takes two years, and what to watch between now and January 2028.
AMA Prior Authorization Survey, May 2026: 13 Hours a Week and How to Count Yours
The AMA released its latest prior authorization physician survey on May 13, 2026: 13 hours of physician and staff time a week, 40 percent of practices with dedicated staff, and only a third of physicians expecting the insurer pledge to help. We explain the findings and how to measure your own practice's burden.
Patient Collections in a High-Deductible Year: What Works in 2026
By May most patients with high-deductible plans still have not met their deductible, which means the practice is the bank. Here is the collections approach we see working: estimates before the visit, cards on file with clear terms, a 30-day statement cycle, a worked example, and a hard stop on stale balances.
EDI Transactions Explained: 837, 999, 277CA, 835 and 270/271 for Practices
Billing staff talk about 837s and 835s as if everyone knows what they are. We explain each of the HIPAA EDI transactions a practice touches, what it carries, where it can fail, which report to look at, and how the files fit together in the life of one claim from eligibility check to posted payment.
OCR's April 2026 Ransomware Settlements Share One Finding: No Risk Analysis
On April 23, 2026 OCR announced four HIPAA settlements totaling $1,165,000, all following ransomware attacks and all citing a missing or inadequate risk analysis. April's breach report also shows 47 large breaches and 1.3 million people affected. Here is what a small practice should do about it, and how long it takes.
Practice Acquisition Billing: New TIN, Enrollment Sequencing and No Payment Gap
When a practice is bought or merged, the clinical work continues on day one but payments often stop for two or three months. We lay out practice acquisition billing step by step: asset versus stock deal, new TIN and NPI, Medicare 855B and reassignments, commercial contracts, old AR run-out and a 120-day timeline.
HIPAA at the Front Desk: Sign-In Sheets, Phone Calls and Minimum Necessary
Most HIPAA problems in a small practice happen at the front desk, not in the server room. We cover what the Privacy Rule actually allows for sign-in sheets, waiting room conversations, phone verification, voicemail, faxes and family members, with a table of common situations and the compliant habit for each.
Well-Child Visit Coding: 99381 to 99395, Same-Day Vaccines and Modifier 25
Well-child visit coding looks simple until a vaccine, a screening and an ear infection land in the same appointment. We walk through the 99381 to 99395 age bands, the Z00.1 diagnosis choices, 90460 versus 90471, the screening add-ons and the modifier 25 decision, with a worked example.
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