Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
RPA in Medical Billing: Tasks That Work, Tasks That Break and a 60-Day Pilot
Robotic process automation promises to take portal clicking off your billers' plates. Some of it delivers. We sort billing office tasks into the ones a bot handles well, the ones that break every quarter, the compliance questions nobody asks the vendor, and a 60-day pilot that tells you whether to keep going.
MIPS 2027 Proposed Changes: Core Measures, MVPs and the End of Traditional MIPS
The CY 2027 Physician Fee Schedule proposed rule carries the biggest Quality Payment Program changes in years: a required MIPS core measure, three new MVPs, a plan to sunset traditional MIPS after 2028 and a new electronic prior authorization measure. Comments close September 14, 2026. What small practices should read.
Five Months to the January 1, 2027 Prior Authorization API Deadline
On January 1, 2027, Medicare Advantage, Medicaid managed care and Marketplace plans must offer a FHIR prior authorization API under CMS-0057-F, and the insurers' 2025 pledge to standardize electronic prior authorization comes due. What will change, what will not, and the five questions to ask your EHR vendor now.
Interpreter Services in a Medical Practice: Legal Duties, T1013 and Who Pays
Practices must provide qualified interpreters to patients who need them, usually at their own expense. We lay out what Title VI, Section 1557 and the ADA require, who may and may not interpret, which Medicaid programs pay HCPCS T1013, the tax credit that offsets sign language costs, and a workflow that holds up.
Billing Supplies in the Office: 99070, HCPCS A Codes and What Payers Bundle
Splints, slings, dressings and trays leave the supply closet every day, and most of them never reach a claim. We explain when 99070 works and when it never will, which HCPCS A, Q and L codes payers actually pay, what NCCI bundles into the procedure, and where the supply dollars are worth chasing.
Chronic Pain Management Codes G3002 and G3003: Requirements and Monthly Billing
Medicare has paid for a monthly chronic pain management bundle since 2023, and most primary care practices still do not bill it. We explain who qualifies, what G3002 and G3003 require in the first visit and every month after, how the 30-minute rule works, and how the codes fit with CCM and PCM.
What to Include in an Eligibility Verification Workflow for Your Front Desk
Eligibility denials are the easiest denials to prevent and among the most common. A workflow that checks the right things at the right three moments, records what was checked, and gives the front desk a script for failures removes most of them. Here is what to include.
The WISeR Model at Six Months: What Practices in the Six States Have Learned
Original Medicare has required prior authorization for skin substitutes, epidural injections, cervical fusion and other services in six states since January 2026. Six months in, the practices doing well share a few habits: one owner for the tracking number, a 120-day watch list and a standard packet.
Commercial Appeal Levels: Internal Appeal, External Review and the ERISA Rights
Most practices stop at the payer's provider appeal and write off what it refuses. Two more levels exist, and they belong to the patient: the internal appeal with regulatory deadlines, and an independent external review that binds the plan. We explain each level, the ERISA rights that go with them, and how to use them.
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