Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CMS Finalizes the Prior Authorization Rule: What Changes in 2026 and 2027
On January 17, 2024, CMS released the Interoperability and Prior Authorization final rule (CMS-0057-F). It sets decision deadlines, requires specific denial reasons and mandates a prior authorization API. Here is who it covers, when each piece lands and what to do before then.
G2211 Is Payable From January 1, 2024: How to Document the Add-On
After a three-year delay, Medicare now pays the G2211 add-on with office and outpatient E/M visits. Here is who qualifies, when the code is not payable, what the note needs to show, and how to set up your billing system so it goes out on the right claims.
The December Revenue Cycle Checklist: Timely Filing, Holidays and January Resets
December is when unworked claims expire and January problems are created. Here is the checklist we run with practices every year: timely filing sweeps, payer holiday cutoffs, the deductible reset conversation, re-verifying Medicaid patients after a year of unwinding, and the IDR portal reopening.
The HHS Cybersecurity Concept Paper: What a Small Practice Should Take From It
On December 6, 2023, HHS published a concept paper on cybersecurity for the health sector: voluntary performance goals, hospital incentives, a HIPAA Security Rule update and enforceable standards. Most of it targets hospitals. Here is what an independent practice should do anyway.
Hiring and Training Medical Billers When Experienced Staff Are Scarce
Every practice manager we talk to this fall has the same open position. Here is what we have learned about hiring billers in a tight market: what to test for instead of years of experience, a 90-day training plan that produces a working biller, and the retention mistakes that send them to the hospital across town.
The 2024 Fee Schedule Final Rule: What Practices Must Change Before January 1
CMS issued the CY 2024 Physician Fee Schedule final rule on November 2, 2023. The conversion factor falls 3.4% to $32.74, G2211 becomes payable, the MIPS threshold stays at 75 points, and caregiver training codes are covered. Here is the practice-level checklist for the eight weeks before it takes effect.
Building a Credentialing Revalidation Calendar That Outlives Your Coordinator
A lapsed revalidation stops every claim for a provider, usually with no warning. Here is how to build the one document that prevents it: every provider, every payer, every date, with realistic lead times, the fields it must carry, and the monthly routine that keeps it alive after the person who built it leaves.
Medicare Advantage Now Covers a Majority: Preparing Your Practice for January
Medicare open enrollment runs October 15 to December 7, 2023. KFF reports that 30.8 million people, 51% of eligible beneficiaries, are in Medicare Advantage this year. Here is what plan switching does to a practice in January, what the CMS-4201-F prior authorization rules change on January 1, and how to prepare now.
ICD-10-CM FY 2024 Is in Effect: 395 New Codes and the SDOH Additions to Know
The FY 2024 ICD-10-CM update took effect October 1, 2023, with 395 new codes, 25 deletions and 13 revisions. Nearly half the additions are external cause codes, and the social determinants of health codes grew again. Here is what changes for office coding and how to check the first two weeks of claims.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.