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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Appeal a Timely Filing Denial: CO-29, Proof of Filing and the Letter
CO-29 denials are not always final. Clearinghouse acceptance reports, payer acknowledgments and eligibility history can prove the claim was filed on time or that the clock started later than the payer thinks. Here is what counts as proof, what does not, and the letter we send.
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.
Credentialing Before January: Network Checks, CAQH, Revalidation and New Plans
January brings new plans, terminated plans, new providers and payer contract changes at the same time. Here is the credentialing checklist we run in the last days of the year and the first days of January so that no provider is out of network or out of revalidation when the January claims go out.
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.
MIPS 2026 Final Policies: The 75-Point Threshold Stays and Six New MVPs Arrive
The 2026 Quality Payment Program policies were finalized with the Physician Fee Schedule on October 31, 2025. The performance threshold stays at 75 points through 2028, six new MVPs arrive, and traditional MIPS survives for now. Here is what to decide before January and what the 2025 submission window looks like.
Payer Changes for 2026: Cigna Downcoding, Prior Auth Pledges and MA Plan Exits
Cigna paused its automatic E/M downcoding policy days before its October 1 start, but it is not dead. Insurers promised prior authorization changes by January 1, 2026, and UnitedHealthcare, Humana and Aetna are leaving counties for 2026. Here is what each change means in the billing office.
Medicare Telehealth Flexibilities End September 30: A Plan for October Visits
With four days left, Congress has not extended the Medicare telehealth flexibilities that end September 30, 2025, and a government shutdown looks likely on October 1. Here is exactly what lapses, what stays, and how to handle the October schedule and the claims.
Denial Prevention for High-Dollar Procedures: A Pre-Claim Review That Pays
A denied $28,000 implant claim costs more than a hundred denied office visits. Here is how to define high-dollar claims, the eleven-point check before they leave the practice, a worked example, and why this matters more with WISeR arriving in January 2026.
Credentialing Timelines for Fall Hires: Counting Backward From the Start Date
A provider starting October 1 whose file opened in late August will not be enrolled with most commercial payers until winter. Here is the calendar math for fall hires, what can still be rescued, how to schedule around pending payers, and the billing rules that are not shortcuts.
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