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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Third Next Available Appointment and Same-Day Capacity: Access Measures for PCMH
Every primary care practice believes its access is fine until it measures it. Here is how to compute third next available appointment, same-day capacity and the other access measures NCQA expects, how to read them, and how to turn a nine-day wait into a report you can act on and submit.
Hospital Charge Capture for Office-Based Physicians Who Round: Closing the Gap
Physicians who see patients in the hospital and bill from the office lose charges in the hand-off between the two buildings. We show where hospital charge capture for physicians breaks, how to reconcile the hospital census against billed encounters and the weekly routine that closes the gap.
Advance Care Planning Codes 99497 and 99498: Documentation, Time and the AWV
Advance care planning is one of the few conversations Medicare pays for separately, and most practices either never bill it or bill it without the time and content the codes require. Here is how 99497 and 99498 work, the 16-minute threshold, modifier 33 with the wellness visit, and a note template.
Billing 99211 Nurse Visits Correctly: What Qualifies and What Gets Missed
Nurse visits are either billed for things that don't qualify or never billed at all. Here is what billing 99211 nurse visits correctly requires: an actual evaluation and management service, Medicare's incident-to supervision rules, the services 99211 can never be billed with, and the charges practices forget.
Medicaid Work Requirements Arrive January 2027: Eligibility Outreach Starts Now
The 2025 reconciliation law requires expansion states to apply an 80-hour monthly work requirement to most adults aged 19 to 64 by January 1, 2027, with a federal rule due June 1, 2026 and six-month renewals to follow. Here is what states are doing this spring and how a practice protects its Medicaid revenue.
Building a Denial Work Queue That Pays: Sort by Dollars, Deadline and Fix Type
Most billing teams work denials oldest first, which is how $14 balances get touched while $2,400 authorization denials pass their appeal deadline. Here is how we build a denial work queue sorted by expected payment, days to deadline and fix type, with the fields, the scoring and the numbers to watch.
UnitedHealthcare April 2026 Bulletin: PC/TC Edits and Genetic Test Authorization
UnitedHealthcare's April 2026 bulletin brings a PC/TC policy change for radiology billed with an E/M from April 1, new genetic and molecular codes needing prior authorization for commercial and exchange plans, and Gold Card list changes. Here is what to check in your charge master and authorization lists.
NCCI Edits Version 32.1 Took Effect April 1, 2026: What Changed, What to Check
The April 2026 NCCI update added more than 3,750 procedure-to-procedure pairs, deleted more than 4,800, and changed 121 medically unlikely edits, including cutting G0447 to one unit per day. Here is how to read the files, which specialties are touched and how to reconcile the edits against your own top code pairs.
Compliance Program for a Small Medical Practice: The Seven Elements, Year One
A compliance program for a small medical practice does not need a department. It needs the seven OIG elements scaled to your size, a realistic first-year calendar and a folder of documents you can hand to an auditor. Here is what we set up, in what order, and what to keep.
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