Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Billing Office Standard Operating Procedures: The 12 SOPs Every Practice Needs
When the one biller who knows how things work goes on leave, the practice discovers it has no billing office standard operating procedures. We list the twelve SOPs every practice should write, the one-page format that actually gets read, who owns each one, and the triggers that keep them current instead of decorative.
AMA Prior Authorization Survey, May 2026: 13 Hours a Week and How to Count Yours
The AMA released its latest prior authorization physician survey on May 13, 2026: 13 hours of physician and staff time a week, 40 percent of practices with dedicated staff, and only a third of physicians expecting the insurer pledge to help. We explain the findings and how to measure your own practice's burden.
Denial Appeals That Quote the Payer's Own Policy Back to Them: A Working Method
The appeals that get paid are the ones that cite the payer's published policy by name, section and effective date, and show the claim meets it. Here is how we build that appeal in under 30 minutes, where to find the policy, the mapping table that does the work, and which denial codes respond to it.
Buy-and-Bill Economics for Office Practices: ASP Plus 6, Sequestration, Margin
Buy-and-bill drugs look profitable on the fee schedule and thin in the bank account. We work through what Medicare actually pays after sequestration, what acquisition, carrying cost, wastage and uncollected coinsurance take back, and a break-even check you can run for every drug in the refrigerator.
UnitedHealthcare Changes Modifier 78 Payment on June 1, 2026: What to Check
UnitedHealthcare's May 2026 reimbursement bulletin moves modifier 78 payment from a flat 84 percent to the CMS intraoperative percentage for each code, effective June 1 for commercial claims. Here is what changes, a worked example, how to model your exposure, and the other policies that picked up code updates.
Aetna Gold Carding Starts May 1, 2026 in Colorado: How the Exemptions Work
Aetna's April provider newsletter announced a prior authorization exemption program for fully insured Colorado commercial members beginning May 1, 2026. Here is how gold carding prior authorization works, which states and payers have it, and how to build the approval log that earns it.
Coding Joint Injections 20610, Trigger Points 20552 and the Drug Line
In-office injections are short procedures with long coding rules: joint size, laterality, ultrasound guidance, muscle counts for trigger points, and a drug line that has to carry the right J code, units and wastage modifier. Here is how we code 20610, 20611, 20552 and 20553 so they pay the first time.
A Pre-Visit Planning Template for Primary Care: The Huddle That Closes Care Gaps
Most care gaps that stay open were missed at a visit where the patient was already in the room. We share the pre-visit planning template for primary care we build with practices: who does it, what fields it has, how the ten-minute morning huddle uses it, what it does for PCMH evidence and the numbers to track.
Onboarding a New Medical Biller in 2026: A 90-Day Plan Built on Real Claims
Most billers learn by being handed a work queue and hoping. It takes a year and produces bad habits. Here is the 90-day onboarding plan we use, week by week: what a new biller should be able to do at 30, 60 and 90 days, the claims to practice on, and the mistakes that show you where to slow down.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.