Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CMS 855I, 855B and 855R Explained: Medicare Enrollment Forms for Practices
Medicare enrollment has its own alphabet: the 855I for the individual, the 855B for the group, the 855R to connect them, and PECOS to hold it all. We explain which form does what, the order to file them, what triggers a rejection, and the maintenance rules that keep a practice from being deactivated.
How to Bill a Medicare Annual Wellness Visit (G0438, G0439) Without Denials
The Medicare Annual Wellness Visit pays well, has no patient cost-share and denies constantly for reasons that have nothing to do with medicine. We cover the three codes, the twelve-month rule, what has to be in the note, the same-day problem visit, and the eligibility check that prevents most of the denials.
When to Use Modifier 25 and How to Document the Separate E/M Visit
Modifier 25 is the most audited two digits in office billing. We explain when to use modifier 25, what "significant and separately identifiable" means in a real note, how the preventive-plus-problem visit works, and why practices either leave it off and lose the visit or add it by reflex.
A 2026 Credentialing Calendar: Revalidations, Re-Attestations and Renewals
Credentialing work that is missed does not announce itself until a claim denies or a payer terminates the provider. Here is the calendar we keep for every provider: the 120-day CAQH cycle, Medicare revalidation, payer recredentialing, licenses, DEA, CLIA and the 30-day NPPES rule.
How to Set Up a New Payer in the Practice Management System Before Go-Live
A signed contract is not a payer that pays. We walk through the payer record and its three different IDs, EDI, ERA and EFT enrollment, loading the contracted fee schedule with a worked example, and the watched first claim that proves every link works before the rest go out.
Medicare Telehealth Extended Through 2027: What the January 31 Lapse Means
The Medicare telehealth flexibilities lapsed on January 31 while H.R. 7148 moved between the Senate and the House. The bill extends them through December 31, 2027. Here is what was extended, what happened to claims during the gap, and what to do this week.
New Patient vs Established Patient: Three-Year Rule and the Denials It Causes
Most staff know one part of the new patient rule and not the other two. We walk through the three-year clock, the same group and same specialty tests, Medicare's NP and PA rule, the B16 denial it causes, and the quieter loss: established visits that should have been billed as new.
UnitedHealthcare Anatomical Modifier Policy Starts February 1, 2026: A Checklist
For dates of service on or after February 1, 2026, UnitedHealthcare commercial and exchange plans require the most specific anatomical or laterality modifier on surgical and radiology codes, and lines without it may deny. Here is the modifier table, the codes most at risk and the scrubber rules to add.
Payer 1099 Reconciliation: Matching January Tax Forms to Posted Payments
Every payer that paid your practice more than $600 last year mails a 1099 in January. Most practices hand the envelope to the accountant. We think the billing office should open it first, because the gap between the 1099 total and what you posted is a map to missing money.
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