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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Read an ERA: The 835 Remittance Advice, CARC, RARC and Group Codes
The electronic remittance advice is the payer's answer to every claim you send, and most physicians have never looked at one. Here is how to read an ERA line by line: the claim and service segments, the CO, PR, OA and PI group codes, the reason and remark codes, and five patterns that signal trouble.
Cross-Training a Small Billing Team So One Absence Does Not Stop Cash
In a two- or three-person billing office, one vacation can stop payment posting for a week and one resignation can stall claims for a month. Here is how we cross-train small teams: the task inventory, the primary and backup grid, the shadowing schedule, one-page procedures and a real test.
Payer Contract Terms Explained: The Clauses That Decide What You Get Paid
Most practices sign payer agreements without reading past the rate exhibit. Here is a plain-language guide to the terms that govern your revenue: lesser-of language, fee schedule references, timely filing, recoupment lookbacks, all-products clauses, amendment by notice and termination.
How to Choose a Practice Management System: What Billing Needs From It
Most practice management system demos are run for the physician and the front desk, and the billing team gets twenty minutes at the end. Here is what billing actually needs: the eligibility, claim, remittance, reporting and contract features to test, the data ownership questions and a scoring sheet.
MIPS 2025 Submission Is Open: A Twelve-Week Plan to Get Data In Before March 31
The 2025 MIPS performance year submission window opened January 2 and closes March 31, 2026 at 8 p.m. Eastern. Here is how we sequence the work: eligibility checks, quality measure completeness, promoting interoperability attestations and improvement activities.
Modifier 59 vs XE, XS, XP and XU: When to Use Each and How NCCI Reads Them
Modifier 59 is the most audited modifier in outpatient coding, and the X modifiers CMS introduced in 2015 were meant to replace most uses of it. Here is what each one means, how NCCI edit indicators decide whether any of them will work, examples by specialty and the documentation behind the claim.
Prior Authorization Clocks Start January 1: 72 Hours, 7 Days, a Written Reason
CMS-0057-F now requires Medicare Advantage, Medicaid and CHIP plans to decide urgent prior authorization requests within 72 hours and standard requests within seven calendar days, and to give a specific denial reason. Here is what changed on January 1 and how to hold payers to it.
HIPAA Security Risk Analysis for a Small Practice: How to Do One That Holds Up
OCR says a missing or inadequate risk analysis shows up in most of its Security Rule enforcement actions, and since October 2024 it has run an initiative aimed at that failure. Here is how a small practice actually does one: the inventory, the threat list, the scoring, the document and the plan.
Deductible Season Collections: A Front Desk Plan for the First Quarter of 2026
Deductibles reset on January 1, the Part B deductible is $283 this year, and many marketplace patients moved to bronze plans with higher out-of-pocket costs. Here is how we set up time-of-service collections, estimates and payment plans for the first quarter.
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