Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Time-Based E/M Coding: What Counts in Total Time on the Date of the Encounter
Time-based E/M coding lets you level an office visit on total time instead of medical decision making, but only certain minutes count. Here is the 2026 threshold table, the activities that count and the ones that do not, a worked 99214 example and the documentation auditors look for.
The April 1, 2026 ICD-10-CM Update Has No New Codes, but It Changes Sequencing
The mid-year ICD-10-CM update effective April 1, 2026 adds no diagnosis codes. It converts 16 Excludes1 notes to Excludes2, turns the I16.1 and H40.84 instructions into "code also" notes, and moves Parkinson's disease indexing to G20.A1. Here is what coders and claim scrubbers need to change today.
Open Payments Review Opens April 1, 2026: What Physicians Should Check by May 15
From April 1 to May 15, 2026 physicians, PAs and NPs can review the payments drug and device companies reported about them for 2025 before CMS publishes the data on June 30. What Open Payments is, why records are often wrong, how to register and dispute, and the practice policy that keeps next year's list short.
WISeR at Three Months: Prior Authorization in Traditional Medicare in Six States
Since January 1, 2026 the CMS WISeR model has applied prior authorization to a short list of services in traditional Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Here is how it works, what practices in those states have run into so far, and what to watch if you are elsewhere.
Prolonged Services Coding: 99417 vs G2212, Time Thresholds and Documentation
A 62-minute follow-up visit is worth more than a 99215, but only if you know which prolonged code the payer accepts and at what minute it starts. We explain 99417 and Medicare's G2212, the 55, 69, 75 and 89 minute thresholds, the time statement that survives an audit, and the mistakes that get these add-ons denied.
Unspecified Diagnosis Codes, Laterality and Seventh Characters: Avoiding Denials
The diagnosis code is the part of the claim physicians control most and check least. When an unspecified code is acceptable and when it will deny, how laterality and the seventh character work, the codes office practices get wrong most often, and the documentation phrases that let a coder pick the specific code.
Incident-To Billing and Split/Shared Visits: The Rules for NPs and PAs in 2026
NPs and PAs now deliver a large share of visits in independent practices, and how those visits are billed decides whether the practice is paid 100 percent or 85 percent of the fee schedule. The incident-to rules for the office, the split/shared rules for facilities, a worked example and the audit questions.
Payers Must Post Prior Authorization Metrics by March 31, 2026: How to Read Them
Under CMS-0057-F, Medicare Advantage, Medicaid managed care, CHIP and exchange plans must publish their 2025 prior authorization approval, denial, appeal and turnaround numbers by March 31, 2026. Here is where to find them, what they can and cannot tell you, and how to use them in appeals and contract talks.
The Marketplace 90-Day Grace Period: Why Claims Pend in Months Two and Three
Eligibility says active, the claim goes out, and nothing comes back for weeks. The patient is in the Marketplace 90-day grace period, and the plan may hold your claim until the premium is paid or coverage is cancelled retroactively. We explain the rule, why 2026 is a bad year for it, and how to protect the practice.
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