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 Renewals, CAQH Attestations and Revalidations in December
Licenses, DEA registrations, CAQH attestations, Medicare revalidations and payer recredentialing all expire on their own calendars, and several cluster at year-end. Here is the December review we run, the intervals for each item, and the failures that stop payment for a whole provider without warning.
Coding G2211 and the New APCM Codes G0556 to G0558 Correctly Before January 1
Two Medicare codes will decide a lot of primary care revenue in 2025: the G2211 complexity add-on, with its new modifier 25 exception, and the monthly Advanced Primary Care Management codes G0556 to G0558. Here are the rules, the documentation, worked examples and the combinations that deny.
Year-End Deductible Strategy: Scheduling, Estimates and Collections
Patients with met deductibles want care before January 1; patients with unmet deductibles owe more than they expect. Here is how to use the remaining-deductible data you already have, how to estimate accurately, why online payments matter most in January, and the mistakes that turn December volume into March bad debt.
After the Election: Five Health Policy Items Practices Are Watching Now
The November 5 election is over and the practical questions for practices are the ones that were pending before it: the December 31 telehealth expiration, the 2.83% Medicare cut, ACA subsidy timing, Medicare Advantage disruption during open enrollment, and cybersecurity rules. Here is what is decided and what is not.
CY2025 Physician Fee Schedule Final Rule: 2.83% Cut, APCM Codes and Telehealth
CMS published the CY2025 Physician Fee Schedule final rule on November 1, 2024. The conversion factor falls to $32.35, three Advanced Primary Care Management codes arrive, G2211 gains a modifier 25 exception, and Medicare declines to pay for 16 of the 17 new CPT telemedicine codes. Here is what changes on January 1.
Change Healthcare Breach Reaches 100 Million: What Practices Owe and Should Ask
Change Healthcare told federal regulators on October 22, 2024 that about 100 million breach notices have gone out, the largest healthcare breach ever reported. Here is where a practice's HIPAA obligations stand, what the notification delegation means, and the questions to put to every vendor that touches your claims.
How to Run a Fourth-Quarter Denial Review, Including the Timely Filing Check
A fourth-quarter denial review has one purpose: recover what can still be recovered in 2024 and stop the same denials from following you into January. Here is the report set, the buckets by cause, the timely filing audit that belongs in the same week, a worked example, and how to turn the findings into three fixes.
UnitedHealthcare's Gold Card Started October 1: Who Qualifies and What Changes
UnitedHealthcare launched a national Gold Card program on October 1, 2024 that waives prior authorization for qualifying groups on selected codes. Here is how eligibility works at the TIN level, why "no prior auth" still means an advance notification, and how to check and protect your status.
ICD-10-CM FY2025 Takes Effect Today: 252 New Codes and First-Week Checks
The FY2025 ICD-10-CM update is live for dates of service from October 1, 2024: 252 new codes, 36 deletions and 13 revisions. Here are the additions primary care and specialty practices will actually use, the deletions that cause rejections, a worked example, and a first-week checklist.
Page 37 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.