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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The G2211 Modifier and the 50% Same-Day E/M Cut: Modeling the CY 2027 Proposal
Two proposals in the July 14 physician fee schedule rule move money in opposite directions. A 16 percent G2211 modifier helps high-level visit mixes and hurts low-level ones. Paying same-day E/M visits with globals at 50 percent hurts anyone doing office procedures. Here are the numbers, worked through.
PAMA Lab Data Reporting 2026 Closes July 31: Which Office Labs Must Report
The clinical laboratory fee schedule data reporting window that opened May 1 ends this Friday, July 31, 2026. Many physician practices with in-office labs are applicable laboratories and do not know it. We explain the two tests, what has to be reported, how, the penalties, and what the 2026 appropriations law changed.
What Is a Work RVU? How Productivity and Medicare Payment Are Calculated
Work RVUs drive compensation formulas, productivity reports and every Medicare fee, and most physicians learn them by osmosis. We explain the three RVU components, the geographic adjustment and conversion factor, how a 99214 becomes a dollar amount, and where wRVU-based compensation goes wrong.
Contractual Adjustment vs Write-Off: The Codes Every Practice Should Separate
When every reduction in a patient balance is posted to one adjustment code, the practice cannot tell contract discounts from lost revenue. We define the difference, propose a short list of adjustment codes, show what the monthly adjustment report should look like, and flag the compliance rules around discounts.
Cloned Documentation: What Auditors Flag and How to Configure the EHR
Copy-forward makes a note faster to write and easier to lose an audit with. We describe how reviewers identify cloned documentation, the patterns that turn a 99214 into a 99212 on review, what the OIG and CMS have said, and the EHR settings, policy and monthly audit that keep the convenience without the exposure.
The WISeR Model at Six Months: What Practices in the Six States Have Learned
Original Medicare has required prior authorization for skin substitutes, epidural injections, cervical fusion and other services in six states since January 2026. Six months in, the practices doing well share a few habits: one owner for the tracking number, a 120-day watch list and a standard packet.
Commercial Appeal Levels: Internal Appeal, External Review and the ERISA Rights
Most practices stop at the payer's provider appeal and write off what it refuses. Two more levels exist, and they belong to the patient: the internal appeal with regulatory deadlines, and an independent external review that binds the plan. We explain each level, the ERISA rights that go with them, and how to use them.
Prior Authorization Turnaround Tracking: The Log That Wins Appeals
Since January 1, 2026, Medicare Advantage, Medicaid managed care and Marketplace plans must decide most prior authorizations within seven days, or 72 hours when expedited. Practices that log every request against those clocks win appeals and have data for payer meetings. Here is the log, field by field.
CY 2027 Telehealth Proposals, Modifiers BB and BC, New MVPs and PE Stabilizer
Beyond the conversion factor cut, the CY 2027 Physician Fee Schedule proposed rule released July 14, 2026 carries telehealth, quality program and practice expense changes that will reach every practice. We read the sections most coverage skipped and explain what changes on claims and in MIPS reporting.
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