Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Denial Root-Cause Analysis vs Denial Follow-Up: Why You Need Both
Follow-up fixes the claim on your screen. Root-cause analysis finds the forty others like it and stops the next forty. Most practices only do the first. Here is how to do the second with a denial log, eight categories and a monthly hour, without a data team.
RPA in Medical Billing: Tasks That Work, Tasks That Break and a 60-Day Pilot
Robotic process automation promises to take portal clicking off your billers' plates. Some of it delivers. We sort billing office tasks into the ones a bot handles well, the ones that break every quarter, the compliance questions nobody asks the vendor, and a 60-day pilot that tells you whether to keep going.
PCMH Annual Reporting in a Year of Coverage Churn: Keeping Panels Honest
Recognized practices report to NCQA every year, and 2026 is a year when panels are about to move: Medicaid six-month renewals and work requirements arrive in December and Marketplace premiums are rising for 2027. Here is how to keep empanelment, quality data and care management accurate through the churn.
MIPS 2027 Proposed Changes: Core Measures, MVPs and the End of Traditional MIPS
The CY 2027 Physician Fee Schedule proposed rule carries the biggest Quality Payment Program changes in years: a required MIPS core measure, three new MVPs, a plan to sunset traditional MIPS after 2028 and a new electronic prior authorization measure. Comments close September 14, 2026. What small practices should read.
What an RCM Audit Should Actually Evaluate, and What the Report Should Contain
A useful revenue cycle audit follows the money from the appointment book to the bank deposit. If the report does not include unbilled encounters, submission lag and a remittance sample, it is a sales call with a spreadsheet. Here are the seven components and how to read the findings.
Interpreter Services in a Medical Practice: Legal Duties, T1013 and Who Pays
Practices must provide qualified interpreters to patients who need them, usually at their own expense. We lay out what Title VI, Section 1557 and the ADA require, who may and may not interpret, which Medicaid programs pay HCPCS T1013, the tax credit that offsets sign language costs, and a workflow that holds up.
How to Bill Newborn Claims: The 30-Day Enrollment Window and Month-Two Denials
Newborn claims pay in month one and deny in month two because nobody added the baby to the plan. We walk through the three coverage clocks that start at delivery, how to bill under the mother's ID, the CARC codes that follow, and the front desk script that stops the problem.
Medicare 2026-2027 Flu Vaccine Payment Allowances: Codes, Rates, Roster Billing
CMS posted the Medicare Part B payment allowances for the 2026-2027 flu season on July 31, effective August 1, 2026. High-dose, adjuvanted and recombinant vaccines all land at $122.52 this year. Here are the codes, the rates, the administration rules and the flu clinic setup we recommend before September.
Talking to Patients About 2027 Coverage Changes: Scripts, Letters and Timing
Marketplace insurers want a 15 percent median premium increase for 2027, Medicaid expansion adults face six-month renewals and work requirements, and deductibles reset in January. Patients will ask your staff what to do. Here is what to say, when to say it, and the four letters to have ready.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.