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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
MIPS 2024 Data Submission Closes March 31, 2025: A Last-Month Checklist
The 2024 MIPS performance year submission window closes March 31, 2025 at 8 p.m. Eastern, and a missed submission can mean a payment cut of up to 9 percent on 2026 Medicare Part B claims. Here is how we work through the last four weeks without surprises, including what small practices get automatically.
Credentialing a Provider Who Starts in Q1: A Plan When You Are Already Late
A physician starts April 1 and the enrollment file was opened last week. It happens every winter. Here is how we triage the payer list, what Medicare allows retroactively, how to schedule around pending plans, and the claim-holding discipline that keeps timely filing intact.
Change Healthcare Breach Now 190 Million People: What Practices Do Next
UnitedHealth Group told regulators on January 24, 2025 that the February 2024 Change Healthcare attack affected about 190 million people, up from 100 million. Here is what that means for a practice's own obligations, its vendor list, the 2024 claims backlog and its clearinghouse contingency plan.
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.
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.
Telehealth Extended to March 31 and a Proposed HIPAA Security Rule Overhaul
Congress extended Medicare telehealth flexibilities through March 31, 2025 in the December 21 funding law, three months instead of the two years an earlier draft promised. Six days later OCR proposed the first major HIPAA Security Rule update since 2013. Here is what each means for the first quarter.
Credentialing Renewals, CAQH Attestations and Revalidations in December
Licenses, DEA registrations, CAQH attestations, Medicare revalidations and payer recredentialing all expire on their own calendars, and several cluster at year-end. Here is the December review we run, the intervals for each item, and the failures that stop payment for a whole provider without warning.
Coding G2211 and the New APCM Codes G0556 to G0558 Correctly Before January 1
Two Medicare codes will decide a lot of primary care revenue in 2025: the G2211 complexity add-on, with its new modifier 25 exception, and the monthly Advanced Primary Care Management codes G0556 to G0558. Here are the rules, the documentation, worked examples and the combinations that deny.
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.
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