Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Medication Reconciliation Workflow for PCMH: Who, When and How to Document
Every practice says it reconciles medications; few can show a report proving it. We lay out a medication reconciliation workflow that satisfies NCQA PCMH criteria KM 14 and KM 15: who collects, who reconciles, who signs, the triggers that start it, what the note must contain and the numbers to report each month.
The Front-Desk Training Refresh We Recommend Before Summer 2026
Summer brings new staff, vacation coverage and patients with changed insurance. A two-hour front-desk refresh in late May prevents most of the eligibility, copay and authorization errors that show up as denials in August. Here is the agenda we use, the six things to practice, and how to check it worked.
In-Office Lab Billing: CLIA Waived Tests, the QW Modifier and Panel Rules
A point-of-care A1c or strep test is easy to run and easy to bill wrong. We cover in-office lab billing from the CLIA certificate that has to be on the claim, to the QW modifier and the nine codes that do not need it, panels versus components, Medicare frequency limits and the denial code behind each mistake.
Hospice Billing for Physicians: GV and GW Modifiers and the Attending Rules
The day a patient elects hospice, the physician office's Medicare claims start denying with CO-B9. Hospice billing for physicians turns on two questions: is this doctor the designated attending, and is this visit related to the terminal illness? We explain the GV and GW modifiers and who bills whom.
Mid-Year Payer Policy Changes for July 2026: Anthem, Aetna and the Sweep
Anthem posted reimbursement policy updates on May 1, 2026 that take effect July 1, and Aetna's allowed maximum fee schedule update starts July 15. We explain what has been announced, why mid-year changes catch practices off guard, and the six-week payer policy sweep we run every May and June.
Vaccine Administration Billing: 90471, 90472, 90460 and G0008 Explained
Vaccines are the most frequently underbilled service in primary care. We explain vaccine administration billing from product code to administration code, when the 90460 counseling codes apply, Medicare's G codes and the Part D split, VFC rules, and the five denials on nearly every pediatric remittance.
Credentialing Summer Hires: The Timeline for Providers Starting in July 2026
Residency ends in June, and new physicians start in July and August. If their credentialing did not begin in March, they will see patients whose claims cannot be billed. Here is the realistic timeline for Medicare, Medicaid and commercial payers, what to do when it is already late, and how to bill during the gap.
What the OIG Is Auditing in Physician Practices in 2026: Incident-To and CCM
The HHS Office of Inspector General published a report on office-based vascular procedures on May 4, 2026, has an active national audit of incident-to billing, and added a chronic care management audit in March. We explain what each one is looking for and how a practice checks itself before someone else does.
Ambient AI Scribes in 2026: What Coders and Billers Need to Check in the Note
The AMA's 2026 survey found 81 percent of physicians now use AI at work, and documentation leads the list. Scribe notes are longer, cleaner and sometimes wrong in ways that affect E/M levels. Here is what we check when a practice turns on a scribe, the five documentation failures we see most, and the 60-day audit.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.