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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CY2026 Fee Schedule Final Rule: Two Conversion Factors and One Efficiency Cut
CMS released the CY2026 Physician Fee Schedule final rule on October 31, 2025. The conversion factor rises to $33.40, or $33.57 for advanced APM participants, but a 2.5 percent efficiency adjustment hits procedural codes and skin substitutes move to a flat per-square-centimeter rate. Here is what changes on January 1.
Payer Changes for 2026: Cigna Downcoding, Prior Auth Pledges and MA Plan Exits
Cigna paused its automatic E/M downcoding policy days before its October 1 start, but it is not dead. Insurers promised prior authorization changes by January 1, 2026, and UnitedHealthcare, Humana and Aetna are leaving counties for 2026. Here is what each change means in the billing office.
A Shutdown Cash-Flow Playbook for Independent Practices in October 2025
Seventeen days into the shutdown, the MACs are holding every physician fee schedule claim with an October date of service and CMS has given no end date. Here is how to forecast the gap, which payers are unaffected, and seven moves that keep payroll safe if this runs into November.
FY2026 ICD-10-CM Update: 487 New Codes and Where Coders Will Get Them Wrong
The FY2026 ICD-10-CM code set took effect on October 1, 2025 with 487 new codes, 38 revisions and 28 deletions. Here is what changed, the chapters that matter for office practices, and the workflow mistakes that turn a code update into a denial spike.
Shutdown Day One: Medicare Telehealth Waivers Lapse and CMS Holds the Claims
The federal government shut down on October 1, 2025 and the Medicare telehealth waivers expired with it. CMS has told the MACs to hold affected claims for ten business days. Here is what reverted, who is affected, and what to do with this week's telehealth visits.
Medicare Telehealth Flexibilities End September 30: A Plan for October Visits
With four days left, Congress has not extended the Medicare telehealth flexibilities that end September 30, 2025, and a government shutdown looks likely on October 1. Here is exactly what lapses, what stays, and how to handle the October schedule and the claims.
Summer 2025 Payer Policy Roundup: Cigna Downcoding, the AHIP Pledge and HIPAA
Between June and September 2025 insurers promised to cut prior authorization, Cigna announced an E/M downcoding policy effective October 1, CMS closed comments on two payment rules, and the HIPAA Security Rule stayed proposed. Here is what changed, what did not, and what to do before October.
CPT 2026 Code Set Released: 418 Changes and What to Do Before January 1
The AMA released the CPT 2026 code set on September 11, 2025: 288 new codes, 84 deletions and 46 revisions, effective January 1, 2026. Here is what is in it, how it interacts with the fee schedule final rule expected in November, and the charge master and contract work to start now.
Denial Prevention for High-Dollar Procedures: A Pre-Claim Review That Pays
A denied $28,000 implant claim costs more than a hundred denied office visits. Here is how to define high-dollar claims, the eleven-point check before they leave the practice, a worked example, and why this matters more with WISeR arriving in January 2026.
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