Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
OIG Exclusion Screening for a Medical Practice: Monthly Checks, What a Hit Means
OIG exclusion screening means checking every employee and vendor against the LEIE and your state Medicaid list every month. Here is who to screen, how to run the check so it holds up, what a match actually costs, and the steps to take in the first week after a hit.
Credentialing Terms Explained: CAQH, PECOS, NPPES, Delegation, Effective Dates
Credentialing has its own vocabulary, and a physician who does not know it cannot tell whether a delay is normal or a problem. This glossary explains the thirty terms that come up in every enrollment, from NPPES and PECOS to primary source verification, delegated credentialing and retroactive effective dates.
How to Run a Weekly Billing Meeting: Six Numbers, Who Attends, What It Decides
Most practices find out about a billing problem when the bank balance drops. A weekly billing meeting finds it four to six weeks earlier. We give the 30-minute agenda built on six numbers, who is in the room, the report each number comes from, a worked example and the three decisions every meeting should end with.
In-Office Lab Billing: CLIA Waived Tests, the QW Modifier and Panel Rules
A point-of-care A1c or strep test is easy to run and easy to bill wrong. We cover in-office lab billing from the CLIA certificate that has to be on the claim, to the QW modifier and the nine codes that do not need it, panels versus components, Medicare frequency limits and the denial code behind each mistake.
Credentialing Summer Hires: The Timeline for Providers Starting in July 2026
Residency ends in June, and new physicians start in July and August. If their credentialing did not begin in March, they will see patients whose claims cannot be billed. Here is the realistic timeline for Medicare, Medicaid and commercial payers, what to do when it is already late, and how to bill during the gap.
Billing Office Standard Operating Procedures: The 12 SOPs Every Practice Needs
When the one biller who knows how things work goes on leave, the practice discovers it has no billing office standard operating procedures. We list the twelve SOPs every practice should write, the one-page format that actually gets read, who owns each one, and the triggers that keep them current instead of decorative.
Practice Acquisition Billing: New TIN, Enrollment Sequencing and No Payment Gap
When a practice is bought or merged, the clinical work continues on day one but payments often stop for two or three months. We lay out practice acquisition billing step by step: asset versus stock deal, new TIN and NPI, Medicare 855B and reassignments, commercial contracts, old AR run-out and a 120-day timeline.
Medicaid Managed Care Billing: Enrollment, Taxonomy Codes and Retro Eligibility
Medicaid managed care billing fails for reasons that have nothing to do with the visit: a missing state enrollment, a taxonomy code that does not match the state file, coverage that arrived three months late, or a filing window that closed. Here is how the rules work and how we set a practice up for them.
Underpayments Hiding in First-Quarter Remits: The Fee Schedule Variance Check
Payers loaded new fee schedules in January, and some of them loaded the wrong one. A denial shows up in a report; an underpayment posts as paid and disappears. Here is the quarterly variance check we run: which contracts to load, how to reprice a sample, which reductions are legitimate, and how to get a systematic fix.
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