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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
MIPS 2027 Under the CY 2027 Proposal: New MVPs, Core Measures and a 2029 Sunset
Comments on the CY 2027 fee schedule proposal closed September 14, and the Quality Payment Program section is the part practices have read least. Here is what CMS proposed for MIPS 2027: three new MVPs, core measures, a changed Promoting Interoperability list and the end of traditional MIPS after 2028.
MIPS 2026 Year-End Checkpoints: What Must Be True by December 31
The 2026 MIPS performance year ends December 31, the threshold is 75 points and the penalty for missing it is up to 9 percent of 2028 Part B payments. Here is the September checkpoint list: performance periods that must already be running, data completeness, the security risk analysis and the submission window.
CY 2027 Physician Fee Schedule Proposal: Comments Closed, What to Budget For
CMS proposed a 2027 conversion factor of $32.84 for most physicians, a 1.68 percent cut from 2026, plus a new payment reduction for E/M visits on the day of a global procedure. Comments closed September 14. Here is what the proposal means for a practice budget and what to watch for in the final rule.
Flu Shot Billing for 2026 to 2027: G0008, Vaccine Codes and Payer Rules
CMS has posted the Medicare Part B payment allowances for 2026 to 2027 influenza vaccines, effective August 1, and clinics are stocked. Here is how we set up flu shot billing for the season: G0008 versus 90471, the product codes, Z23, Medicare Advantage routing, roster billing and the October denials.
Medicaid Work Requirements Start January 2027: Preparing Your Front End
Under Public Law 119-21 and the CMS interim final rule issued June 1, 2026, states must apply an 80-hour monthly community engagement requirement to Medicaid expansion adults by January 1, 2027. Here is what it changes for eligibility, documentation and patient conversations in an independent practice.
How to Identify Revenue Leakage in a Medical Practice: A Six-Point Checklist
Leakage hides in small, repeatable failures. Here is a practical method for finding it: the six places to look, the exact reports to pull, how to put a dollar figure on each finding, and how to assign every leak to a process owner and a weekly check.
Prior Authorization for Drugs: Pharmacy vs Medical Benefit and Step Therapy
A drug denied at the pharmacy counter and a drug denied before an infusion are two different problems with two different rulebooks. Here is how prior authorization for drugs works under the pharmacy benefit and the medical benefit, what step therapy requires, the Medicare clocks, and the fastest route to an approval.
Small-Practice Breach Response: The First 72 Hours and Who to Call
The IT vendor calls at 4:40 on a Friday: the files are encrypted. What the practice does in the next three days decides the cost of the next year. Here is a breach response plan for a small medical practice: containment, the call list in order, the incident log, the 60-day HIPAA clock and the risk assessment.
Physical Therapy Billing in a Physician Practice: Units, KX and Plan of Care
Adding a physical therapist to an orthopedic or primary care practice adds a billing rulebook nobody on the staff has read. Here is how physical therapy billing in a physician practice works: counting timed units under the 8-minute rule, the 2026 KX threshold, plan of care certification and the PTA modifier.
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