Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Card on File Policy for Medical Practices: Consent, Limits and the Workflow
Keeping a patient's card on file and charging the balance after the claim adjudicates can cut patient AR sharply, or generate complaints and chargebacks if done carelessly. Here is the policy we recommend: the consent form, the dollar cap, the notice before the charge, and the technology rules.
How to Choose a Practice Management System: What Billing Needs From It
Most practice management system demos are run for the physician and the front desk, and the billing team gets twenty minutes at the end. Here is what billing actually needs: the eligibility, claim, remittance, reporting and contract features to test, the data ownership questions and a scoring sheet.
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.
Change Healthcare Breach Now 190 Million People: What Practices Do Next
UnitedHealth Group told regulators on January 24, 2025 that the February 2024 Change Healthcare attack affected about 190 million people, up from 100 million. Here is what that means for a practice's own obligations, its vendor list, the 2024 claims backlog and its clearinghouse contingency plan.
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.
Ascension's Cyberattack and the Downtime Plan Every Independent Practice Needs
Ascension detected the attack on May 8. Nine days later, orders, results and billing across one of the largest health systems in the country are running on paper. Here is what it means for the practices that refer to Ascension hospitals, and the downtime plan every independent practice should write now.
The 2023 CAQH Index: What Manual Transactions Cost a Small Practice
CAQH released its eleventh Index on January 30, 2024. Administrative spending on the nine tracked transactions rose sharply, and prior authorization is still mostly manual. Here is how to read the report from a practice's side of the desk and which transactions are worth automating first.
ChatGPT in the Billing Office: What Generative AI Can and Cannot Do in 2023
Six months after ChatGPT launched, billers and practice managers are already pasting denial letters into it. Some of that is useful and some of it is a privacy incident. Here is what these tools do well today, where they fail at coding and payer rules, and the three-rule policy every practice should write this month.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.