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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Third Next Available Appointment and Same-Day Capacity: Access Measures for PCMH
Every primary care practice believes its access is fine until it measures it. Here is how to compute third next available appointment, same-day capacity and the other access measures NCQA expects, how to read them, and how to turn a nine-day wait into a report you can act on and submit.
Open Payments Review Opens April 1, 2026: What Physicians Should Check by May 15
From April 1 to May 15, 2026 physicians, PAs and NPs can review the payments drug and device companies reported about them for 2025 before CMS publishes the data on June 30. What Open Payments is, why records are often wrong, how to register and dispute, and the practice policy that keeps next year's list short.
PCMH Care Plans That Meet the Care Management Criteria: Elements and Cadence
A PCMH care plan is not a problem list with a date on it. NCQA's care management criteria ask for patient goals, barriers, a self-management plan and a written copy in the patient's hands, reviewed on a schedule. We lay out the elements, a worked example and a review cadence that keeps annual reporting painless.
PCMH Version 11.1 Is Now the Standard: Evidence Habits for 2026 Annual Reporting
NCQA PCMH Standards and Guidelines version 11.1 took effect January 1, 2026, raising the medication reconciliation threshold to 90.1 percent and tightening care plan documentation. Recognized practices report against it this year. Here is what changed and the weekly habits that make the evidence easy.
Colorectal Cancer Screening Gaps: A March Workflow for the HEDIS COL Measure
March is Colorectal Cancer Awareness Month, and it is when payer gap lists for the year arrive. How to find every patient aged 45 to 75 without a qualifying screening, which tests close the gap and for how long, the Medicare and commercial codes, and a tiered outreach plan a small practice can run.
Care Gap Lists Arrive in February: Turning Payer Quality Reports into Visits
Every February the Medicare Advantage and commercial plans send their first care gap lists of the measurement year. Most sit in an inbox. Here is how to reconcile them against the chart, close the documentation gaps with CPT II codes, and turn the real gaps into visits before the summer.
What Is Empanelment in Primary Care and How to Build Accurate Patient Panels
Empanelment is the foundation PCMH recognition, quality reporting and care gap work all rest on, and most practices have never done it deliberately. We define what empanelment is in primary care, walk through the four-cut method for assigning patients, work out panel size, and show how to keep the list true.
MIPS Payment Adjustments on 2026 Medicare Remits: CARC 144, 237 and Remark N807
Since January 1, every Medicare Part B remit carries the result of your 2024 MIPS score, as a small increase or a cut of up to nine percent. We explain how the 2026 MIPS payment adjustment appears on the remit, how to verify it against your final score, and what to do if the numbers disagree.
Risk Stratification for Care Management in Primary Care: A PCMH Workflow
PCMH standards expect a practice to identify which patients need care management and to show how it decided. Here is a risk stratification method a small primary care practice can run from its own EHR data: the criteria, the tiers, the monthly list, the care manager hand-off and the NCQA evidence.
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