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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
MIPS 2025 Midyear Checkpoint: Eligibility, PI Window and Quality Completeness
The 2025 MIPS performance year has a 75-point threshold and a penalty of up to 9 percent on 2027 Medicare payments. Late July is the last realistic moment to fix eligibility, Promoting Interoperability and quality data problems. Here is the checklist we run with practices.
OBBBA Medicaid Changes: What Practice Eligibility Workflows Need Now
The One Big Beautiful Bill Act became law on July 4, 2025. Its Medicaid provisions arrive in stages from 2026 to 2028, but the eligibility habits that will protect a practice need to start this year. Here is what changed, when, and what to do about it.
Medicaid Eligibility Checks After the Unwinding: What Still Goes Wrong
The Medicaid unwinding is over, but the churn it created is not. Over 25 million people were disenrolled, most for paperwork reasons, and many came back under a different managed care plan. Here is how eligibility for Medicaid patients actually fails at the front desk in 2025 and the checks that catch it.
House Passes the One Big Beautiful Bill: Medicaid Changes Practices Should Track
The House passed H.R. 1 by a single vote on May 22, 2025. Its Medicaid provisions, including work requirements, six-month redeterminations and new cost sharing for expansion adults, now go to the Senate. Nothing is law yet, but the direction is clear enough that practices with Medicaid patients should start planning.
UnitedHealth's CEO Change and MA Scrutiny: What It Means for Your Practice
UnitedHealth Group replaced its chief executive on May 13, 2025, suspended its 2025 outlook and cited rising medical costs in Medicare Advantage, all amid press reports of Department of Justice investigations into MA billing. Here is what a large payer under pressure tends to do next, and how practices should prepare.
Payer Recoupments and Takebacks: What to Do Between the Letter and the Offset
A recoupment starts as a letter or a strange line on a remittance and ends as money withheld from unrelated claims. The steps in between, and the deadlines attached to them, decide whether the practice keeps the money, repays it on its own terms, or loses track of it entirely.
Clearinghouse Contingency Planning a Year After the Change Healthcare Attack
The February 2024 ransomware attack on Change Healthcare stopped claims, remittances and eligibility for weeks and exposed data on about 190 million people. A year on, here is what actually changed in how practices route transactions, what a real contingency plan contains, and how to test it before you need it.
HHS Restructuring, a New Secretary and the Medicaid Budget Fight: What to Watch
In ten weeks, HHS got a new Secretary, the House passed a budget resolution that points at Medicaid, and on March 27, 2025 HHS announced a plan to cut about 20,000 positions and fold 28 divisions into 15. Here is what happened, what it does and does not change for a practice, and what to watch.
Building a Monthly RCM Scorecard: The Twelve Numbers and Where to Pull Them
A monthly revenue cycle scorecard is one page, twelve numbers, the same definitions every month, and a name next to each. Here is the list we use, the formula for each, where the data comes from, the ranges that suggest a problem, a sample page, and the mistakes that make scorecards useless.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.