Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The Six-Month Revenue Leakage Review: What to Pull Before July 1, 2026
Half the year is gone and most practices have not checked whether January's fixes held. Here is the mid-year leakage review we run: the six reports, the window to use, how to size each finding in dollars, who owns each fix, and the three numbers that decide whether the second half looks like the first.
Closing Care Gaps Before Mid-Year: Turning Q1 Payer Gap Lists Into Visits
Payer gap lists for measurement year 2026 arrived in the first quarter and most of them are sitting in an inbox. April to June is when closing them is easiest. Here is how to reconcile the lists against your own data, which measures to prioritize, how to code closures so they count, and how to run the outreach.
Medicaid Managed Care Billing: Enrollment, Taxonomy Codes and Retro Eligibility
Medicaid managed care billing fails for reasons that have nothing to do with the visit: a missing state enrollment, a taxonomy code that does not match the state file, coverage that arrived three months late, or a filing window that closed. Here is how the rules work and how we set a practice up for them.
Your Practice Website Should Do Three Jobs: Intake, Payments and Fewer Calls
Most practice websites are a brochure: a photo of the building, a list of doctors, a phone number. The ones that pay for themselves do three operational jobs. Here is what each job requires, the HIPAA and accessibility rules that apply, and how to measure whether the site helps the front desk or just decorates.
Aetna Gold Carding Starts May 1, 2026 in Colorado: How the Exemptions Work
Aetna's April provider newsletter announced a prior authorization exemption program for fully insured Colorado commercial members beginning May 1, 2026. Here is how gold carding prior authorization works, which states and payers have it, and how to build the approval log that earns it.
How to Choose a Clearinghouse for a Medical Practice: The Questions to Ask
A clearinghouse touches every claim and remittance, and most practices picked theirs because the practice management vendor suggested it. Here is how to choose a clearinghouse for a medical practice: what it should do, the questions that separate vendors, and how to switch without losing a month of cash.
A Small Balance Write-Off Policy for a Medical Practice: What to Put in Writing
Every practice writes off small balances; few have a policy that says which ones, who approves it and how it is reported. We lay out the adjustment types a small balance write-off policy should define, the thresholds that work, the Medicare rules that limit routine waivers and the monthly report that catches leakage.
Coding Joint Injections 20610, Trigger Points 20552 and the Drug Line
In-office injections are short procedures with long coding rules: joint size, laterality, ultrasound guidance, muscle counts for trigger points, and a drug line that has to carry the right J code, units and wastage modifier. Here is how we code 20610, 20611, 20552 and 20553 so they pay the first time.
Underpayments Hiding in First-Quarter Remits: The Fee Schedule Variance Check
Payers loaded new fee schedules in January, and some of them loaded the wrong one. A denial shows up in a report; an underpayment posts as paid and disappears. Here is the quarterly variance check we run: which contracts to load, how to reprice a sample, which reductions are legitimate, and how to get a systematic fix.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.