Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Prior Authorization Software: What the 2027 API Deadlines Do and Do Not Fix
Every vendor pitch this year mentions the January 1, 2027 deadline for payer prior authorization APIs. The deadline is real and useful, but it covers only some payers and depends on your EHR. Here is what the APIs will do, what they will not, and the questions to ask before signing.
When the EHR and Billing System Disagree: Fixing Charge Interface Errors
When the EHR and the billing system are separate products, every charge crosses an interface, and interfaces drop things quietly. We explain how a charge travels from the signed note to the claim, the charge interface errors we see most, and the daily three-way count that finds a missing encounter within a day.
Care Gap Lists Arrive in February: Turning Payer Quality Reports into Visits
Every February the Medicare Advantage and commercial plans send their first care gap lists of the measurement year. Most sit in an inbox. Here is how to reconcile them against the chart, close the documentation gaps with CPT II codes, and turn the real gaps into visits before the summer.
What Is Empanelment in Primary Care and How to Build Accurate Patient Panels
Empanelment is the foundation PCMH recognition, quality reporting and care gap work all rest on, and most practices have never done it deliberately. We define what empanelment is in primary care, walk through the four-cut method for assigning patients, work out panel size, and show how to keep the list true.
How to Bill J-Codes and Drug Units in the Office Without Losing the Charge
Every injection and infusion in an office carries two charges: the drug and the administration. Practices lose one or the other constantly. We explain how to bill J-codes and drug units, work the unit math on common drugs, cover the JW and JZ modifiers, and show where the charge falls out of the workflow.
A $103,000 Phishing Settlement and the HIPAA Risk Analysis for a Small Practice
On February 19, 2026, OCR settled with an Illinois treatment center for $103,000 after a phishing attack exposed 1,980 patients' records. The finding was not the phishing. It was the missing risk analysis. Here is what the settlement requires, and how a small practice performs the analysis OCR keeps asking for.
The HIPAA Security Rule Update Is Still a Proposal: What to Do While You Wait
HHS proposed the first major rewrite of the HIPAA Security Rule on January 6, 2025. Thirteen months later it is still not final, provider groups have asked for it to be scaled back, and OCR is enforcing the existing rule aggressively. Here is what the proposal would require and what to do now.
Incident-To Billing Requirements: The Rules, the 85 Percent Math and Audit Traps
Billing a nurse practitioner's visit under the physician's NPI pays 15 percent more from Medicare and is legal only under specific conditions. We lay out the incident-to billing requirements, work the math on when it is worth it, and describe the four failures that turn a routine visit into an overpayment.
How to Bill APCM in 2026: G0556 to G0558 and the New Behavioral Health Add-Ons
Advanced Primary Care Management pays a monthly amount per Medicare patient with no time tracking. For 2026, CMS added three add-on codes for behavioral health integration and collaborative care. Here is how the codes fit together, what must be documented, and what cannot be billed alongside them.
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