Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Bill a Sports Physical: Back-to-School Visits, Codes and Payer Rules
August fills the schedule with sports physicals, well-child visits and vaccine catch-up. Most of the write-offs we see in September come from mixing those three up on the claim. Here is how to bill a sports physical correctly, when to combine it with the annual well visit, and what to tell parents at check-in.
Medicaid Work Requirement Rule Takes Effect July 31: A Front-Desk Guide
CMS's June 1, 2026 interim final rule on Medicaid work requirements takes effect July 31. States must finish initial outreach by August 31, run the 80-hour test by January 1, 2027, and move expansion adults to six-month renewals. Here is the timeline and the front-desk workflow.
Commercial Appeal Levels: Internal Appeal, External Review and the ERISA Rights
Most practices stop at the payer's provider appeal and write off what it refuses. Two more levels exist, and they belong to the patient: the internal appeal with regulatory deadlines, and an independent external review that binds the plan. We explain each level, the ERISA rights that go with them, and how to use them.
CY 2027 Telehealth Proposals, Modifiers BB and BC, New MVPs and PE Stabilizer
Beyond the conversion factor cut, the CY 2027 Physician Fee Schedule proposed rule released July 14, 2026 carries telehealth, quality program and practice expense changes that will reach every practice. We read the sections most coverage skipped and explain what changes on claims and in MIPS reporting.
Billing Staff Productivity Benchmarks: Claims per FTE and Touches per Claim
Most practices measure billing staff by how busy they look. We lay out the numbers that actually describe a billing office, claims per FTE, touches per claim, denials resolved per day and posting speed, show how to pull them from your own system, and pair each with an accuracy measure so speed never beats correctness.
Nursing Facility Visit Coding for Rounding Physicians: 99304 to 99316 Explained
Physicians who round at nursing facilities lose more revenue to uncaptured visits than to denials. We explain the 99304 to 99316 codes as they have worked since the 2023 changes, the MDM and time thresholds, who may perform which visit, and a census reconciliation that finds the visits that never became claims.
ACA Insurers Propose a 14% Median Premium Increase for 2027: Practice Impact
KFF's July 8 analysis of 77 Marketplace insurers in 16 states and DC found a median proposed premium increase of 14 percent for 2027, the second straight year of double-digit requests. For practices that means plan switching, higher deductibles and self-pay conversions in January. Here is how to prepare.
Qualified Medicare Beneficiary Billing Rules: Spot QMB Status, Refund Mistakes
Federal law bars practices from billing Qualified Medicare Beneficiaries for Medicare deductibles, coinsurance and copays, yet statements still go out to them. We explain how QMB works, where the status shows up on eligibility and remits, how to post the balance, and how to refund what was collected in error.
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.
Page 4 of 18 · 156 articles
Want this level of attention on your own revenue cycle?
The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.