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.
Texting Patients Appointment Reminders: TCPA and HIPAA Rules for Practices
Text reminders cut no-shows, and they also sit under two federal laws. We explain the rules for texting patients appointment reminders: the healthcare exemption and its limits, what consent to record, the opt-out rules in force and the one delayed to 2027, and what a reminder may say.
HIPAA Training for Medical Office Staff: Topics, Cadence and the Records to Keep
HIPAA training is required, but the rules say little about content, and most practices buy a video and file the certificates. We describe HIPAA training for medical office staff that matches a small practice's real risks: topics by role, scenarios that teach, the cadence and the records an investigator asks for.
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.
Five Months to the January 1, 2027 Prior Authorization API Deadline
On January 1, 2027, Medicare Advantage, Medicaid managed care and Marketplace plans must offer a FHIR prior authorization API under CMS-0057-F, and the insurers' 2025 pledge to standardize electronic prior authorization comes due. What will change, what will not, and the five questions to ask your EHR vendor now.
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.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.