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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The Medical Billing Process Explained Step by Step: From Scheduling to Zero Balance
Medical billing is a chain of fourteen linked steps, and a claim is only as clean as the weakest one. We walk the whole process in order, from the first phone call to the day the balance hits zero, with the reports we watch and the places where money quietly leaks.
How to Benchmark Your Medical Practice Against Survey Data, Without the Traps
A practice owner reads that median days in AR is in the low thirties, sees 47 on her own report, and starts a fire drill. The survey measured something different. Here is how to benchmark your medical practice against survey data: the metrics, computing yours the survey's way, the specialty adjustments and the traps.
ICD-10-CM FY 2027 Takes Effect October 1: 190 New Codes and a Cutover Checklist
The FY 2027 ICD-10-CM update, with 190 new codes, 30 deletions and four revised titles, applies to all encounters on or after October 1, 2026. Here is what changed, the codes primary care and specialty practices will actually use, and the cutover checklist to run in the nine days that remain.
MIPS 2027 Under the CY 2027 Proposal: New MVPs, Core Measures and a 2029 Sunset
Comments on the CY 2027 fee schedule proposal closed September 14, and the Quality Payment Program section is the part practices have read least. Here is what CMS proposed for MIPS 2027: three new MVPs, core measures, a changed Promoting Interoperability list and the end of traditional MIPS after 2028.
How to Identify Revenue Leakage in a Medical Practice: A Six-Point Checklist
Leakage hides in small, repeatable failures. Here is a practical method for finding it: the six places to look, the exact reports to pull, how to put a dollar figure on each finding, and how to assign every leak to a process owner and a weekly check.
Prior Authorization for Drugs: Pharmacy vs Medical Benefit and Step Therapy
A drug denied at the pharmacy counter and a drug denied before an infusion are two different problems with two different rulebooks. Here is how prior authorization for drugs works under the pharmacy benefit and the medical benefit, what step therapy requires, the Medicare clocks, and the fastest route to an approval.
Payer Policy Monitoring: A Monthly Routine for Bulletins and Scrubber Rules
Payers change reimbursement policies every month and tell you in bulletins nobody reads. We describe a two-hour monthly routine: which sources to check and when, how to triage what applies to you, the change log fields that matter, and how to turn a policy notice into a scrubber rule before the effective date.
Writing a CMS Comment That Gets Read: OPPS Closes August 31, PFS September 14
The CY 2027 OPPS comment period closes August 31, 2026 and the physician fee schedule period closes September 14. Most practices have never commented and assume it is pointless. It is not, but a useful comment looks different from an angry one. Here is the structure, three worked examples and the mistakes to avoid.
Denial Root-Cause Analysis vs Denial Follow-Up: Why You Need Both
Follow-up fixes the claim on your screen. Root-cause analysis finds the forty others like it and stops the next forty. Most practices only do the first. Here is how to do the second with a denial log, eight categories and a monthly hour, without a data team.
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