Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CMS WISeR Model Brings Prior Authorization to Traditional Medicare in Six States
On June 27, 2025, the CMS Innovation Center announced the WISeR model, bringing prior authorization to a list of traditional Medicare services in six states from January 1, 2026. Here is what is covered, how the review works, and what practices in those states should do before January.
The June 23 Prior Authorization Pledge: What Changes in 2026 and 2027
On June 23, 2025, health insurers covering about 257 million Americans committed through AHIP and HHS to simplify prior authorization, with deadlines in 2026 and 2027. Here is what was promised, how it lines up with the CMS rule already on the books, and how to design your workflow now.
FY 2026 ICD-10-CM: 487 New Codes Arrive October 1. Here Is How to Prepare Now
CMS and the CDC have posted the fiscal year 2026 ICD-10-CM files: 487 new codes, 28 deletions and 38 revisions, effective October 1, 2025. Here is what is in the update for office-based practices, which specialties are most affected, and a June-to-October preparation plan that avoids the first-week rejection spike.
Medicaid Eligibility Checks After the Unwinding: What Still Goes Wrong
The Medicaid unwinding is over, but the churn it created is not. Over 25 million people were disenrolled, most for paperwork reasons, and many came back under a different managed care plan. Here is how eligibility for Medicaid patients actually fails at the front desk in 2025 and the checks that catch it.
Mid-Year Revenue Leakage Check: Six Things That Changed in January 2025
Every January brings a new conversion factor, new codes, new payer contracts and reset deductibles, and every June is the right time to check whether the practice actually caught them. Here are six leakage sources specific to the first half of 2025, the report that exposes each one, and how to size what you find.
Credentialing With Medicare Advantage Plans: What Differs From Original Medicare
A provider enrolled in PECOS can bill Medicare on day one and still be out of network with every Medicare Advantage plan in town. Here is how MA credentialing actually works, why the timelines differ, how the preclusion list fits in, and the sequence that gets a new provider paid by MA plans without a gap.
House Passes the One Big Beautiful Bill: Medicaid Changes Practices Should Track
The House passed H.R. 1 by a single vote on May 22, 2025. Its Medicaid provisions, including work requirements, six-month redeterminations and new cost sharing for expansion adults, now go to the Senate. Nothing is law yet, but the direction is clear enough that practices with Medicaid patients should start planning.
UnitedHealth's CEO Change and MA Scrutiny: What It Means for Your Practice
UnitedHealth Group replaced its chief executive on May 13, 2025, suspended its 2025 outlook and cited rising medical costs in Medicare Advantage, all amid press reports of Department of Justice investigations into MA billing. Here is what a large payer under pressure tends to do next, and how practices should prepare.
Payer Recoupments and Takebacks: What to Do Between the Letter and the Offset
A recoupment starts as a letter or a strange line on a remittance and ends as money withheld from unrelated claims. The steps in between, and the deadlines attached to them, decide whether the practice keeps the money, repays it on its own terms, or loses track of it entirely.
Page 34 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.