Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Provider Offboarding Checklist: Reassignment, Payer Notices and the 30-Day Trap
When a physician leaves, the practice has 30 days to tell Medicare, payer contracts with their own notice clauses, and months of claims that still need to pay. Our provider offboarding checklist covers enrollment terminations, reassignment end dates, forwarding claims and the notice deadlines practices miss.
Place of Service Codes: POS 11, 19, 22, 02 and 10, and the Cost of a Wrong One
A two-digit field on every claim line decides whether a payer uses the facility or non-facility rate, and whether the service is even allowed where you say it happened. We explain POS 11, 19, 22, 02 and 10, the CO-5 and CO-58 denials a wrong code produces, and the quiet underpayments nobody sees.
Medicare Telehealth Flexibilities Run Through 2027: Spring 2026 Billing Rules
The Consolidated Appropriations Act, 2026, signed February 3, 2026, extended the major Medicare telehealth waivers through December 31, 2027. After a fall lapse and a January cliff, practices finally have a stable rulebook. Here is what is covered, how to code it, and what to fix from the gap.
UnitedHealthcare Medicare Advantage Enforces Excludes1 Edits From March 1, 2026
UnitedHealthcare told its network that Medicare Advantage claims of every type, including professional claims, are subject to ICD-10-CM Excludes1 edits for dates of service on or after March 1, 2026. What Excludes1 means, the diagnosis pairs that trip it most in office practice, and how to keep clean claims clean.
First-Quarter 2026 Revenue Review: The Eight Numbers to Pull Before April Starts
March is when the January payer and fee schedule changes show up in real remittances. Here are the eight numbers we pull for every practice at the end of Q1, how to read each one against the 2026 Medicare conversion factor and the January deductible reset, and what a bad number usually means.
Global Surgical Package Rules: 0, 10 and 90-Day Periods and the Four Modifiers
Office practices lose money on both sides of the global surgical package: billing visits that are bundled and writing off visits that are payable. We explain the 0, 10 and 90-day periods, what is inside the package, and when modifiers 24, 58, 78 and 79 apply, with a worked split-care example.
MIPS 2025 Data Submission Closes March 31, 2026: A Four-Week Checklist
The submission window for the 2025 MIPS performance year closes at 8 pm Eastern on March 31, 2026. Here is what to verify in the QPP portal this month, the numbers that decide whether you clear the 75-point threshold, and the mistakes that cost practices a 9 percent cut in 2027.
HEDIS Chart Review Season Runs February to May 2026: How to Handle Requests
Health plans are pulling charts for HEDIS measurement year 2025 from February through May 2026. Here is what the requests are, why HIPAA allows you to answer them, how to run the work without losing a medical records clerk for a month, and how to cut next year's volume with CPT Category II codes.
When to Use an ABN: Advance Beneficiary Notice Rules for Medical Practices
The Advance Beneficiary Notice is the only way to bill a Medicare patient for a service Medicare denies as not reasonable and necessary, and most practices use it wrong in both directions. We explain when to use an ABN, when not to, how to fill it in, the GA and GX modifiers, and the 2026 form version question.
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