Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
When to Use Modifier 25 and How to Document the Separate E/M Visit
Modifier 25 is the most audited two digits in office billing. We explain when to use modifier 25, what "significant and separately identifiable" means in a real note, how the preventive-plus-problem visit works, and why practices either leave it off and lose the visit or add it by reflex.
A 2026 Credentialing Calendar: Revalidations, Re-Attestations and Renewals
Credentialing work that is missed does not announce itself until a claim denies or a payer terminates the provider. Here is the calendar we keep for every provider: the 120-day CAQH cycle, Medicare revalidation, payer recredentialing, licenses, DEA, CLIA and the 30-day NPPES rule.
How to Set Up a New Payer in the Practice Management System Before Go-Live
A signed contract is not a payer that pays. We walk through the payer record and its three different IDs, EDI, ERA and EFT enrollment, loading the contracted fee schedule with a worked example, and the watched first claim that proves every link works before the rest go out.
Medicare Telehealth Extended Through 2027: What the January 31 Lapse Means
The Medicare telehealth flexibilities lapsed on January 31 while H.R. 7148 moved between the Senate and the House. The bill extends them through December 31, 2027. Here is what was extended, what happened to claims during the gap, and what to do this week.
New Patient vs Established Patient: Three-Year Rule and the Denials It Causes
Most staff know one part of the new patient rule and not the other two. We walk through the three-year clock, the same group and same specialty tests, Medicare's NP and PA rule, the B16 denial it causes, and the quieter loss: established visits that should have been billed as new.
UnitedHealthcare Anatomical Modifier Policy Starts February 1, 2026: A Checklist
For dates of service on or after February 1, 2026, UnitedHealthcare commercial and exchange plans require the most specific anatomical or laterality modifier on surgical and radiology codes, and lines without it may deny. Here is the modifier table, the codes most at risk and the scrubber rules to add.
Payer 1099 Reconciliation: Matching January Tax Forms to Posted Payments
Every payer that paid your practice more than $600 last year mails a 1099 in January. Most practices hand the envelope to the accountant. We think the billing office should open it first, because the gap between the 1099 total and what you posted is a map to missing money.
Card on File Policy for Medical Practices: Consent, Limits and the Workflow
Keeping a patient's card on file and charging the balance after the claim adjudicates can cut patient AR sharply, or generate complaints and chargebacks if done carelessly. Here is the policy we recommend: the consent form, the dollar cap, the notice before the charge, and the technology rules.
How to Build a Medical Practice Revenue Budget From Your Own Billing Data
Most practice budgets start from last year's deposits plus a percentage, which misses every fee schedule change and payer mix shift in your own data. Here is how to build a medical practice revenue budget from visits, payer mix, contracted rates and collection rates, with a worked example.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.