Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
ACA Credits End December 31 and MA Plans Close: Patient Outreach Before January
Unless Congress acts, the enhanced marketplace premium tax credits expire on December 31, 2025, and millions of Medicare Advantage members are in plans that end the same day. Both mean coverage changes at your front desk in January. Here is the outreach plan the practices we work with are running now.
A Shutdown Cash-Flow Playbook for Independent Practices in October 2025
Seventeen days into the shutdown, the MACs are holding every physician fee schedule claim with an October date of service and CMS has given no end date. Here is how to forecast the gap, which payers are unaffected, and seven moves that keep payroll safe if this runs into November.
Prior Authorization Staffing Models for Independent Practices in 2025
The AMA's latest survey puts prior authorization at 39 requests per physician per week and about 13 hours of staff time. Here is how practices staff it, the volume math for each model, the metrics that tell you it is working, and what the summer 2025 payer commitments change.
Deductible Reset Scripts: What the Front Desk Should Say in January 2025
Every January the deductible resets, half the patients have a new card, and the front desk absorbs the frustration. Here are the scripts we give registration staff, the card fields to check, the eligibility steps that prevent February denials, and a table of scenarios.
Year-End Deductible Strategy: Scheduling, Estimates and Collections
Patients with met deductibles want care before January 1; patients with unmet deductibles owe more than they expect. Here is how to use the remaining-deductible data you already have, how to estimate accurately, why online payments matter most in January, and the mistakes that turn December volume into March bad debt.
FTC Noncompete Rule Set Aside: What It Means for Physician Employment Agreements
On August 20, a federal judge in Texas set aside the FTC's nationwide ban on noncompete agreements, two weeks before it would have taken effect. For medical practices, that means noncompetes remain a matter of state law. Here is what changed, what did not, and the departure checklist that matters more.
When a Local Hospital System Is in Trouble: Protecting Referrals and Payer Mix
Steward Health Care filed for Chapter 11 on May 6 with 31 hospitals and more than $9 billion in liabilities. For independent practices nearby, a hospital system's collapse changes where patients go, which contracts pay and who answers the phone. Here is how to measure the exposure and protect the practice.
Cash Flow During a Payment Interruption: Medicare Advances and Other Options
CMS opened accelerated and advance payments on March 9, 2024 for providers hit by the Change Healthcare outage, and Congress raised the 2024 conversion factor the same day. Here is how the CMS program works, how repayment happens, and the thirteen-week cash plan that carries a practice through the gap.
MIPS 2024: What Changed and What Small Practices Should Set Up Now
The 2024 MIPS year keeps the 75-point threshold but raises data completeness to 75 percent, extends the Promoting Interoperability period to 180 days and adds four MVPs. Here is what each change means for a small practice, plus the decisions to make before the end of March.
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