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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Prior Authorization Turnaround Tracking: The Log That Wins Appeals
Since January 1, 2026, Medicare Advantage, Medicaid managed care and Marketplace plans must decide most prior authorizations within seven days, or 72 hours when expedited. Practices that log every request against those clocks win appeals and have data for payer meetings. Here is the log, field by field.
CY 2027 Physician Fee Schedule Proposal: Conversion Factor Falls to $32.84
CMS released the CY 2027 Medicare Physician Fee Schedule proposed rule on July 14, 2026. The 2.5 percent bump expires, the conversion factor drops to $32.84, G2211 becomes a 16 percent modifier and same-day E/M visits with globals are cut in half. What happened and what to do before September 14.
Workers' Compensation Billing for Practices: Authorization, Fee Schedules, Forms
Workers' compensation claims follow state rules, not payer contracts, and most billing teams learn them by losing money. We cover what to capture before the first visit, how state fee schedules and filing limits work, the reports that must ride with every bill, and the denials that follow when they do not.
A 90-Day Plan for the October 1, 2026 ICD-10-CM Update: 190 New Codes
CMS and the CDC posted the FY 2027 ICD-10-CM files on June 5, 2026: 190 new codes, 30 deletions and four revised titles, effective for dates of service on or after October 1, 2026. It is a quieter year than FY 2026, which is exactly when practices get sloppy. Here is a week-by-week plan from July 7 to October 1.
CY 2027 OPPS and ASC Proposed Rule: What Office Practices Should Read
CMS released the CY 2027 hospital outpatient and ASC proposed rule on July 2, 2026. Most of it is written for hospitals, but the botulinum toxin prior authorization expansion, site-neutral imaging and the inpatient-only list phase-out reach physician practices. Here is what to read and what to skip.
UnitedHealthcare July 2026 Policy Updates: What Your Practice Should Check
UnitedHealthcare posted its July 2026 monthly overview and policy bulletins on July 1. Most items are quarterly code housekeeping, but a DME process change in eleven states, three prior authorization changes with fall dates and several state Medicaid items deserve a look now.
July 2026 NCCI Edits and HCPCS Update: What to Load Before Your Next Claim Run
The third-quarter code update took effect July 1, 2026: a new HCPCS Level II file, practitioner NCCI edits version 322 and the Q3 add-on code edits. Here is what changed in the cycle, where each file lives, and the order in which we load and test them.
Medicaid Provider Tax Changes on June 30 and October 1, 2026: What They Mean
Two dates this year begin the unwinding of Medicaid provider taxes under last year's budget law: non-uniform managed care tax arrangements end with most state fiscal years on June 30, and provider tax rates are frozen from October 1. What the law does, the phase-down that follows, and why practices should care.
Pre-Service Financial Clearance for Procedures: Verify, Estimate, Collect
Pre-service financial clearance means knowing, before the patient arrives for a procedure, that coverage is active, authorization is in hand and the patient knows what they owe. Here is the timeline, the benefit fields to read, a worked estimate and the script that collects it.
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