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 Advantage vs Original Medicare Billing: The Differences for Practices
More than half of Medicare patients now arrive with a plan card rather than a red, white and blue one, and the billing rules change with it. We lay out the Medicare Advantage vs Original Medicare billing differences a practice feels: who to bill, authorizations, rates, timely filing and appeals.
When the EHR and Billing System Disagree: Fixing Charge Interface Errors
When the EHR and the billing system are separate products, every charge crosses an interface, and interfaces drop things quietly. We explain how a charge travels from the signed note to the claim, the charge interface errors we see most, and the daily three-way count that finds a missing encounter within a day.
Incident-To Billing Requirements: The Rules, the 85 Percent Math and Audit Traps
Billing a nurse practitioner's visit under the physician's NPI pays 15 percent more from Medicare and is legal only under specific conditions. We lay out the incident-to billing requirements, work the math on when it is worth it, and describe the four failures that turn a routine visit into an overpayment.
Medical Billing Terms Every Physician Should Know: A Working Glossary
Physicians sign off on billing reports full of words they were never taught. This glossary covers the medical billing terms every physician should know, grouped by where they appear in the revenue cycle, with the number to watch next to each and a note on how each term gets misused.
CMS 855I, 855B and 855R Explained: Medicare Enrollment Forms for Practices
Medicare enrollment has its own alphabet: the 855I for the individual, the 855B for the group, the 855R to connect them, and PECOS to hold it all. We explain which form does what, the order to file them, what triggers a rejection, and the maintenance rules that keep a practice from being deactivated.
A 2026 Credentialing Calendar: Revalidations, Re-Attestations and Renewals
Credentialing work that is missed does not announce itself until a claim denies or a payer terminates the provider. Here is the calendar we keep for every provider: the 120-day CAQH cycle, Medicare revalidation, payer recredentialing, licenses, DEA, CLIA and the 30-day NPPES rule.
How to Set Up a New Payer in the Practice Management System Before Go-Live
A signed contract is not a payer that pays. We walk through the payer record and its three different IDs, EDI, ERA and EFT enrollment, loading the contracted fee schedule with a worked example, and the watched first claim that proves every link works before the rest go out.
New Patient vs Established Patient: Three-Year Rule and the Denials It Causes
Most staff know one part of the new patient rule and not the other two. We walk through the three-year clock, the same group and same specialty tests, Medicare's NP and PA rule, the B16 denial it causes, and the quieter loss: established visits that should have been billed as new.
How to Build a Medical Practice Revenue Budget From Your Own Billing Data
Most practice budgets start from last year's deposits plus a percentage, which misses every fee schedule change and payer mix shift in your own data. Here is how to build a medical practice revenue budget from visits, payer mix, contracted rates and collection rates, with a worked example.
Page 5 of 8 · 66 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.