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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The CY 2026 Physician Fee Schedule Is Live: What Changes on Your January Remits
The 2026 Medicare fee schedule took effect January 1 with two conversion factors, a 2.5 percent efficiency adjustment on procedural work and a flat rate for skin substitutes. Here is what to check when the first remits of the year arrive.
What Is a Clean Claim Rate and How to Measure It in Your Practice
A clean claim rate tells you how many claims pay on the first pass without anyone touching them again. Here is how we define it, how to pull it from your practice management system, what a good number looks like and the five fixes that move it.
Credentialing Before January: Network Checks, CAQH, Revalidation and New Plans
January brings new plans, terminated plans, new providers and payer contract changes at the same time. Here is the credentialing checklist we run in the last days of the year and the first days of January so that no provider is out of network or out of revalidation when the January claims go out.
Fee Schedules and CPT 2026: What to Load and Test Before the First January Claim
CPT 2026 takes effect January 1 with 288 new codes, 84 deletions and 46 revisions. The Medicare conversion factor, the corrected skin substitute rate, the OPPS update and the 2026 Part B deductible all change the same day. Here is the December checklist we run so the first January claims go out clean.
ACA Credits End December 31 and MA Plans Close: Patient Outreach Before January
Unless Congress acts, the enhanced marketplace premium tax credits expire on December 31, 2025, and millions of Medicare Advantage members are in plans that end the same day. Both mean coverage changes at your front desk in January. Here is the outreach plan the practices we work with are running now.
WISeR Starts January 1: Medicare Prior Authorization Comes to Six States
The WISeR model brings prior authorization to traditional Medicare for the first time at scale, in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, starting January 1, 2026. Skin substitutes, nerve stimulators, epidural steroid injections and knee arthroscopy are on the list. Here is how the workflow changes.
MIPS 2026 Final Policies: The 75-Point Threshold Stays and Six New MVPs Arrive
The 2026 Quality Payment Program policies were finalized with the Physician Fee Schedule on October 31, 2025. The performance threshold stays at 75 points through 2028, six new MVPs arrive, and traditional MIPS survives for now. Here is what to decide before January and what the 2025 submission window looks like.
The Year-End Timely Filing Sweep: What to Run in the Last Six Weeks of the Year
Every December, practices write off claims that were still recoverable in November. Here is the timely filing sweep we run in the last six weeks of the year: the reports, the payer limits, the appeal windows, and how to handle the shutdown-era telehealth claims that are sitting in the queue.
Shutdown Over: Medicare Telehealth Is Back Through January 30. Fix the Claims
The Continuing Appropriations Act, 2026 was signed on November 12, 2025, ending the 43-day shutdown and restoring the Medicare telehealth flexibilities retroactively to October 1 and through January 30, 2026. CMS says shutdown-period claims will be paid as if the lapse never happened. Here is the cleanup list.
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