Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Read an ERA: The 835 Remittance Advice, CARC, RARC and Group Codes
The electronic remittance advice is the payer's answer to every claim you send, and most physicians have never looked at one. Here is how to read an ERA line by line: the claim and service segments, the CO, PR, OA and PI group codes, the reason and remark codes, and five patterns that signal trouble.
The January Claim Edit Tune-Up: Fee Schedules, NCCI Edits and Payer Resets
Every January the billing system runs on last year's fee schedules, last quarter's NCCI edits and payer policies that quietly reset on the first. Here is the tune-up we run in the first two weeks of the year, with the reports that show whether it worked.
The 2026 Medicare Part B Deductible Is $283: What January Remits Will Show
CMS set the 2026 Part B deductible at $283 and the standard premium at $202.90, announced November 14, 2025. From the first visits of the year, most Medicare remits will carry PR-1 instead of payment. Here is how the deductible flows through claims, secondaries and statements, and what the front desk should say.
What Is a Clean Claim Rate and How to Measure It in Your Practice
A clean claim rate tells you how many claims pay on the first pass without anyone touching them again. Here is how we define it, how to pull it from your practice management system, what a good number looks like and the five fixes that move it.
CY2026 Fee Schedule Final Rule: Two Conversion Factors and One Efficiency Cut
CMS released the CY2026 Physician Fee Schedule final rule on October 31, 2025. The conversion factor rises to $33.40, or $33.57 for advanced APM participants, but a 2.5 percent efficiency adjustment hits procedural codes and skin substitutes move to a flat per-square-centimeter rate. Here is what changes on January 1.
Coding Transitional Care Management (99495 and 99496) Without Losing the Visit
Transitional care management pays well and is denied often, usually for reasons the practice controls: a late first contact, a second practitioner billing the same period, or a face-to-face visit coded as a separate E/M. Here is how the 30-day service actually works, what to document, and where the claims fail.
The 2025 Medicare Fee Schedule Is in Effect: What Changes on Your January Claims
The conversion factor dropped to $32.35 on January 1, 2025, G2211 can now be paid with modifier 25 in some visits, and Medicare will not pay most of the new telemedicine CPT codes. Here is what to change in the billing system this month and what to watch.
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.
Billing Medicare Annual Wellness Visits (G0438, G0439) Without the Usual Denials
The annual wellness visit is one of the few Medicare services with no patient cost sharing, and one of the most frequently denied. Here is how the IPPE, first AWV and subsequent AWV fit together, what documentation each requires, how to add a problem visit with modifier 25, and the denials to prevent.
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