Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Medicare Advantage Non-Contracted Providers: Payment, Appeals and the Waiver
A practice that treats a Medicare Advantage patient without a contract is not out of luck. Federal rules set what the plan must pay, how fast, and how to appeal a denial. Here is how the payment floor works, why the waiver of liability form matters, and the mistakes that turn a payable claim into a write-off.
What Practices Should Review Before Outsourcing Medical Billing
Outsourcing billing changes who does the work, not who is responsible for the revenue. Here is what to examine in your own practice first, the questions that separate a billing company from a claim-submission service, and what the agreement must say.
Closing Gaps in Care Before Year-End: Start the Outreach Push in September
Every quality program that pays your practice measures on a calendar year ending December 31, and this year patients are more likely than usual to change plans or lose coverage in January. Practices that run gap outreach from September through early December close more gaps. Here is the plan, step by step.
Payer Policy Monitoring: A Monthly Routine for Bulletins and Scrubber Rules
Payers change reimbursement policies every month and tell you in bulletins nobody reads. We describe a two-hour monthly routine: which sources to check and when, how to triage what applies to you, the change log fields that matter, and how to turn a policy notice into a scrubber rule before the effective date.
FDA Approves 2026-2027 COVID-19 Vaccines: What Practices Set Up Before Billing
On August 27, 2026 the FDA approved four updated COVID-19 vaccines for the 2026-2027 season, targeting the XFG variant and limited to adults 65 and older and younger people with risk conditions. What that means for eligibility screening, vaccine codes and CMS pricing, administration billing and the front desk.
Psychotherapy Time Thresholds: 90832, 90834, 90837 and Add-On Codes Done Right
The 50-minute session is the most common billing error in behavioral health because it is not a 90837. We lay out the minute ranges for every timed psychotherapy code, how the E/M add-ons and crisis codes work, what the note must show about time, and how to spot an outlier pattern before a payer does.
Writing a CMS Comment That Gets Read: OPPS Closes August 31, PFS September 14
The CY 2027 OPPS comment period closes August 31, 2026 and the physician fee schedule period closes September 14. Most practices have never commented and assume it is pointless. It is not, but a useful comment looks different from an angry one. Here is the structure, three worked examples and the mistakes to avoid.
UnitedHealthcare September 1, 2026 Lab Policies: Testosterone, B12, Allergens
UnitedHealthcare's August 2026 bulletin restates five routine test management policies for Medicare Advantage that take effect September 1, 2026, covering testosterone, vitamin B12, allergen testing and more. Here is what each one limits, which practices will see denials, and how to get orders ready.
RPM and RTM Under the CY 2027 Proposal: Initiating Visits and Employed Staff
The CY 2027 physician fee schedule proposal would limit RTM to established patients, require an initiating visit, pay only when clinical staff are the practice's own employees, and asks whether to collapse 17 codes into four G-codes. For practices using a turnkey vendor, that is a business model question.
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