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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
NCCI Edits Version 32.1 Took Effect April 1, 2026: What Changed, What to Check
The April 2026 NCCI update added more than 3,750 procedure-to-procedure pairs, deleted more than 4,800, and changed 121 medically unlikely edits, including cutting G0447 to one unit per day. Here is how to read the files, which specialties are touched and how to reconcile the edits against your own top code pairs.
Compliance Program for a Small Medical Practice: The Seven Elements, Year One
A compliance program for a small medical practice does not need a department. It needs the seven OIG elements scaled to your size, a realistic first-year calendar and a folder of documents you can hand to an auditor. Here is what we set up, in what order, and what to keep.
FY 2027 IPPS Proposed Rule of April 10, 2026: What It Means for Office Practices
CMS released the fiscal year 2027 inpatient hospital payment proposal on April 10, 2026, with comments due June 9. Most of it does not touch a physician office, but the mandatory nationwide joint replacement model, the quality measure changes and the payment update all reach practices that admit, round or refer.
CO-50 Medical Necessity Denials: How to Appeal Them and Stop the Next One
CO-50 is the payer saying the service was not medically necessary, and in our experience most of them are really diagnosis coding or coverage policy problems. Here is how to read the remark codes, find the LCD or payer policy behind the denial, write the appeal and build the front-end check that prevents the repeat.
Patient Balance Workflows for 2026: Statements, Payment Plans and the Stop Point
Patient balances are now a large share of practice AR, and most practices work them badly: late first statements, no text option, no payment plan rules and no defined stop point. Here is the workflow we set up, with timing, dollar thresholds and the reports that show whether it is working.
Coding Diabetes With Complications: E11 Combination Codes, Z79.4 and Z79.84
Most practices code type 2 diabetes as E11.9 and stop, even when the chart shows kidney disease, neuropathy and insulin. Here is how coding diabetes with complications actually works: the E11 subcategories, the "with" convention, the Z79 medication codes, a worked example and the errors auditors flag.
CMS Finalizes 2027 Medicare Advantage Rates: What Practices Should Take From It
On April 6, 2026 CMS released the CY 2027 Medicare Advantage Rate Announcement: a 2.48 percent net payment increase, up sharply from the 0.09 percent advance notice, and a decision to exclude diagnoses from audio-only visits and unlinked chart reviews from risk adjustment. What it means for practices.
The April 2026 HCPCS Quarterly Update: New J Codes and What to Load
The April 1, 2026 HCPCS Level II update added new permanent codes for several injectable drugs, reinstated J1572 retroactive to January 1 and discontinued three L codes without a crosswalk. Here is what practices that bill drugs and DME should load, and how to handle first-quarter claims.
Medicare Participation Status: Par, Non-Par and Opt-Out Billing Rules Explained
A physician's Medicare participation status decides how much the practice is paid, who Medicare sends the check to and what the patient can be billed. Here is how participating, non-participating and opt-out actually work, with a 99214 worked example, the limiting charge math and the deadlines.
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