Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Coding Transitional Care Management (99495 and 99496) Without Losing the Visit
Transitional care management pays well and is denied often, usually for reasons the practice controls: a late first contact, a second practitioner billing the same period, or a face-to-face visit coded as a separate E/M. Here is how the 30-day service actually works, what to document, and where the claims fail.
Clearinghouse Contingency Planning a Year After the Change Healthcare Attack
The February 2024 ransomware attack on Change Healthcare stopped claims, remittances and eligibility for weeks and exposed data on about 190 million people. A year on, here is what actually changed in how practices route transactions, what a real contingency plan contains, and how to test it before you need it.
A 5.06% Medicare Advantage Rate Increase for 2026: What It Means for Practices
CMS finalized a 5.06% average payment increase for Medicare Advantage plans in 2026 on April 7, 2025, well above the January estimate. Here is what drove the number, what the completed V28 risk model phase-in means for coding, and what practices with MA contracts should do before plans file bids in June.
April 1, 2025 ICD-10-CM Update: No New Codes, One Guideline Change That Matters
The April 1, 2025 ICD-10-CM update adds no new diagnosis codes, but it changes how a confirmed COVID-19 diagnosis is coded and quietly edits the index and tabular list. Here is what changed, who it affects, and how to run a mid-year code update without breaking claims.
HHS Restructuring, a New Secretary and the Medicaid Budget Fight: What to Watch
In ten weeks, HHS got a new Secretary, the House passed a budget resolution that points at Medicaid, and on March 27, 2025 HHS announced a plan to cut about 20,000 positions and fold 28 divisions into 15. Here is what happened, what it does and does not change for a practice, and what to watch.
Building a Monthly RCM Scorecard: The Twelve Numbers and Where to Pull Them
A monthly revenue cycle scorecard is one page, twelve numbers, the same definitions every month, and a name next to each. Here is the list we use, the formula for each, where the data comes from, the ranges that suggest a problem, a sample page, and the mistakes that make scorecards useless.
Medicare Telehealth Flexibilities Extended to September 30, 2025: What to Do Now
The full-year continuing resolution signed March 15, 2025 extends Medicare telehealth flexibilities through September 30, 2025, two weeks before they were due to lapse. Here is what was extended, what was not, the billing rules that still apply, and how to unwind the April contingency plans.
How to Write a Medical Necessity Appeal That a Payer Reviewer Will Actually Read
A CO-50 denial is not the end of the claim; it is a request for an argument. Here is the structure we use for medical necessity appeals, the deadlines by payer type, the documents to attach, a worked example, and the mistakes that get well-supported services denied twice.
MIPS 2024 Data Submission Closes March 31, 2025: A Last-Month Checklist
The 2024 MIPS performance year submission window closes March 31, 2025 at 8 p.m. Eastern, and a missed submission can mean a payment cut of up to 9 percent on 2026 Medicare Part B claims. Here is how we work through the last four weeks without surprises, including what small practices get automatically.
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