Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Medicare Participation Status: Par, Non-Par and Opt-Out Billing Rules Explained
A physician's Medicare participation status decides how much the practice is paid, who Medicare sends the check to and what the patient can be billed. Here is how participating, non-participating and opt-out actually work, with a 99214 worked example, the limiting charge math and the deadlines.
Claim Scrubber Rules Worth Adding, Who Owns Them and the Monthly Review
Most practices run their claim scrubber on the vendor's default edits and wonder why the same denials keep coming back. Here are the custom claim scrubber rules worth adding, how to build one from a denial, who should own the rule set and the monthly review that keeps it from rotting.
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.
Incident-To Billing and Split/Shared Visits: The Rules for NPs and PAs in 2026
NPs and PAs now deliver a large share of visits in independent practices, and how those visits are billed decides whether the practice is paid 100 percent or 85 percent of the fee schedule. The incident-to rules for the office, the split/shared rules for facilities, a worked example and the audit questions.
Denial Trends After the January 2026 Payer Changes: What Q1 Remits Are Showing
Three months of 2026 remittances are enough to see which January changes turned into denials. We walk through the CARC codes that rose this quarter, the payer behaviors behind them, and the fixes that stop each category before April claims go out.
Medical Billing and Coding Certifications Explained: CPC, CPB, CCS and CRCR
Practice owners see CPC, CPC-A, CPB, CCS, CRCR and CPCS on resumes and rarely know what each proves. This comparison explains the major billing, coding, credentialing and revenue cycle credentials, who issues them, what the letters do and do not tell you, and how to test the rest.
Which Vendors Need a HIPAA Business Associate Agreement, and Which Do Not
Every practice has a drawer of business associate agreements and a longer list of vendors that never signed one. What makes a vendor a business associate, twenty common vendors sorted into yes and no, the terms the contract must contain and a two-week inventory plan.
Spring Credentialing Revalidations: PECOS Due Dates and CAQH Attestations
Medicare revalidation notices, CAQH re-attestations and commercial recredentialing cycles tend to pile up in spring. Here is how to read the PECOS revalidation list, what a deactivation actually costs, the 120-day CAQH rhythm, and a tracking sheet that keeps a multi-provider practice from missing one.
Provider Offboarding Checklist: Reassignment, Payer Notices and the 30-Day Trap
When a physician leaves, the practice has 30 days to tell Medicare, payer contracts with their own notice clauses, and months of claims that still need to pay. Our provider offboarding checklist covers enrollment terminations, reassignment end dates, forwarding claims and the notice deadlines practices miss.
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