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 Participation Status: Par, Non-Par and Opt-Out Billing Rules Explained
A physician's Medicare participation status decides how much the practice is paid, who Medicare sends the check to and what the patient can be billed. Here is how participating, non-participating and opt-out actually work, with a 99214 worked example, the limiting charge math and the deadlines.
Incident-To Billing and Split/Shared Visits: The Rules for NPs and PAs in 2026
NPs and PAs now deliver a large share of visits in independent practices, and how those visits are billed decides whether the practice is paid 100 percent or 85 percent of the fee schedule. The incident-to rules for the office, the split/shared rules for facilities, a worked example and the audit questions.
CMS Revised the ABN Form on March 13, 2026: When to Issue It and Which Modifier
A revised Advance Beneficiary Notice of Noncoverage, Form CMS-R-131, was approved on March 13, 2026 and must be in use by May 12. What changed, when an ABN is required, when it is prohibited, how to fill it in, and the GA, GX, GY and GZ modifiers that tell Medicare who pays if the claim denies.
Medicare Preventive Services Beyond the Wellness Visit: Screening and Limits
Most primary care offices bill the annual wellness visit and stop. Medicare also pays separately for alcohol screening, depression screening, tobacco counseling, cardiovascular and obesity counseling and a twice-yearly risk assessment, each with its own frequency limit. Here is the list, the rules and a worked visit.
Behavioral Health Integration Billing: 99484, CoCM, G0323 and the 2026 Add-Ons
Most primary care offices screen for depression and then have nowhere to send the positives. Behavioral health integration billing pays for doing the follow-up in-house. We walk through 99484, the collaborative care codes, G0323 for psychologists and social workers, and the APCM add-ons that arrived in January 2026.
Place of Service Codes: POS 11, 19, 22, 02 and 10, and the Cost of a Wrong One
A two-digit field on every claim line decides whether a payer uses the facility or non-facility rate, and whether the service is even allowed where you say it happened. We explain POS 11, 19, 22, 02 and 10, the CO-5 and CO-58 denials a wrong code produces, and the quiet underpayments nobody sees.
Medicare Telehealth Flexibilities Run Through 2027: Spring 2026 Billing Rules
The Consolidated Appropriations Act, 2026, signed February 3, 2026, extended the major Medicare telehealth waivers through December 31, 2027. After a fall lapse and a January cliff, practices finally have a stable rulebook. Here is what is covered, how to code it, and what to fix from the gap.
Incident-To Billing Requirements: The Rules, the 85 Percent Math and Audit Traps
Billing a nurse practitioner's visit under the physician's NPI pays 15 percent more from Medicare and is legal only under specific conditions. We lay out the incident-to billing requirements, work the math on when it is worth it, and describe the four failures that turn a routine visit into an overpayment.
How to Bill a Medicare Annual Wellness Visit (G0438, G0439) Without Denials
The Medicare Annual Wellness Visit pays well, has no patient cost-share and denies constantly for reasons that have nothing to do with medicine. We cover the three codes, the twelve-month rule, what has to be in the note, the same-day problem visit, and the eligibility check that prevents most of the denials.
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