Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
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.
Denial Appeals That Quote the Payer's Own Policy Back to Them: A Working Method
The appeals that get paid are the ones that cite the payer's published policy by name, section and effective date, and show the claim meets it. Here is how we build that appeal in under 30 minutes, where to find the policy, the mapping table that does the work, and which denial codes respond to it.
Medicare Telehealth Runs Through 2027: The Billing Check to Do Now
The Consolidated Appropriations Act, 2026, signed February 3, extended Medicare telehealth flexibilities through the end of 2027 and covered the brief lapse at the start of February. Three months in, here is the place of service, modifier and audio-only check we recommend, a worked example, and what still expires.
Buy-and-Bill Economics for Office Practices: ASP Plus 6, Sequestration, Margin
Buy-and-bill drugs look profitable on the fee schedule and thin in the bank account. We work through what Medicare actually pays after sequestration, what acquisition, carrying cost, wastage and uncollected coinsurance take back, and a break-even check you can run for every drug in the refrigerator.
Waiving Copays and Professional Courtesy: What the Anti-Kickback Statute Allows
Waiving copays for colleagues, staff, friends or struggling patients feels generous and is often illegal. We explain how the Anti-Kickback Statute, the beneficiary inducement rules, the Stark professional courtesy exception and payer contracts treat waivers, and how to write a hardship policy that holds up.
UnitedHealthcare Changes Modifier 78 Payment on June 1, 2026: What to Check
UnitedHealthcare's May 2026 reimbursement bulletin moves modifier 78 payment from a flat 84 percent to the CMS intraoperative percentage for each code, effective June 1 for commercial claims. Here is what changes, a worked example, how to model your exposure, and the other policies that picked up code updates.
The Most Common Denial Codes in a Medical Practice and the Fix for Each One
CO-16, CO-97, CO-4, CO-18, CO-29 and their neighbors make up most of what lands on a remittance. We explain what each of the most common denial codes means, the RARC that usually travels with it, where in the practice it started, and the fix that stops it coming back.
The Medicare Five Levels of Appeal Explained: Deadlines, Dollar Limits and Forms
Redetermination, reconsideration, ALJ hearing, Appeals Council and federal court: the Medicare five levels of appeal each have their own deadline, decision clock and paperwork. We walk through each level with the 2026 dollar thresholds, a worked example and the point where most practices should stop.
The Six-Month Revenue Leakage Review: What to Pull Before July 1, 2026
Half the year is gone and most practices have not checked whether January's fixes held. Here is the mid-year leakage review we run: the six reports, the window to use, how to size each finding in dollars, who owns each fix, and the three numbers that decide whether the second half looks like the first.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.