Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Credentialing Timelines for Fall Hires: Counting Backward From the Start Date
A provider starting October 1 whose file opened in late August will not be enrolled with most commercial payers until winter. Here is the calendar math for fall hires, what can still be rescued, how to schedule around pending payers, and the billing rules that are not shortcuts.
Prior Authorization Staffing Models for Independent Practices in 2025
The AMA's latest survey puts prior authorization at 39 requests per physician per week and about 13 hours of staff time. Here is how practices staff it, the volume math for each model, the metrics that tell you it is working, and what the summer 2025 payer commitments change.
Coding Behavioral Health Integration: CoCM 99492 to 99494 and 99484 Done Right
Collaborative care and general behavioral health integration pay for work most primary care practices already do badly for free. Here are the code requirements, the time thresholds, the documentation that survives an audit, and the mistakes that get these claims denied.
CY 2026 OPPS Proposed Rule: Inpatient-Only List and Site-Neutral Payment
CMS released the CY 2026 OPPS and ASC proposed rule on July 15, 2025: a 2.4 percent update, a three-year phase-out of the inpatient-only list starting with 285 procedures, and site-neutral payment for drug administration in off-campus departments. Here is what it means outside the hospital.
MIPS 2025 Midyear Checkpoint: Eligibility, PI Window and Quality Completeness
The 2025 MIPS performance year has a 75-point threshold and a penalty of up to 9 percent on 2027 Medicare payments. Late July is the last realistic moment to fix eligibility, Promoting Interoperability and quality data problems. Here is the checklist we run with practices.
A 90-Day Plan Before the October 1 ICD-10-CM Update (487 New Codes)
The FY 2026 ICD-10-CM update takes effect October 1, 2025 with 487 new codes, 38 revisions and 28 deletions. The practices that lose money on code updates are the ones that start in September. Here is a week-by-week plan starting now.
The WISeR Model: Prior Authorization Comes to Traditional Medicare in Six States
CMS announced the WISeR model on June 27, 2025. Starting January 1, 2026, certain services in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington will need prior authorization or face pre-payment review in traditional Medicare. Here is how it works and how to prepare.
CY 2026 Physician Fee Schedule Proposed Rule: What Practices Should Model Now
CMS released the CY 2026 Physician Fee Schedule proposed rule on July 14, 2025. Two conversion factors, a 2.5 percent efficiency adjustment, a practice expense cut for facility-based services and a skin substitute overhaul. Here is what to model and what to comment on.
OBBBA Medicaid Changes: What Practice Eligibility Workflows Need Now
The One Big Beautiful Bill Act became law on July 4, 2025. Its Medicaid provisions arrive in stages from 2026 to 2028, but the eligibility habits that will protect a practice need to start this year. Here is what changed, when, and what to do about it.
Page 33 of 44 · 390 articles
Want this level of attention on your own revenue cycle?
The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.