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 Open Enrollment Runs Through March 31, 2026: A Practice Plan
The Medicare Advantage Open Enrollment Period runs January 1 to March 31, 2026, and this year it follows a record wave of plan exits. Patients who switched, or were switched, are arriving with cards that do not match your file. Here is what the period allows and the checks to run.
Cross-Training a Small Billing Team So One Absence Does Not Stop Cash
In a two- or three-person billing office, one vacation can stop payment posting for a week and one resignation can stall claims for a month. Here is how we cross-train small teams: the task inventory, the primary and backup grid, the shadowing schedule, one-page procedures and a real test.
Credentialing vs Contracting vs Enrollment: The Three Steps Practices Confuse
A new physician is not paid until three separate processes finish: credentialing verifies the person, contracting sets the terms, and enrollment loads the provider into the payer system. Here is what each step does, who runs it, how long each takes and where the handoffs fail.
Credentialing Before January: Network Checks, CAQH, Revalidation and New Plans
January brings new plans, terminated plans, new providers and payer contract changes at the same time. Here is the credentialing checklist we run in the last days of the year and the first days of January so that no provider is out of network or out of revalidation when the January claims go out.
Payer Changes for 2026: Cigna Downcoding, Prior Auth Pledges and MA Plan Exits
Cigna paused its automatic E/M downcoding policy days before its October 1 start, but it is not dead. Insurers promised prior authorization changes by January 1, 2026, and UnitedHealthcare, Humana and Aetna are leaving counties for 2026. Here is what each change means in the billing office.
Credentialing Timelines for Fall Hires: Counting Backward From the Start Date
A provider starting October 1 whose file opened in late August will not be enrolled with most commercial payers until winter. Here is the calendar math for fall hires, what can still be rescued, how to schedule around pending payers, and the billing rules that are not shortcuts.
Mid-Year Revenue Leakage Check: Six Things That Changed in January 2025
Every January brings a new conversion factor, new codes, new payer contracts and reset deductibles, and every June is the right time to check whether the practice actually caught them. Here are six leakage sources specific to the first half of 2025, the report that exposes each one, and how to size what you find.
Credentialing With Medicare Advantage Plans: What Differs From Original Medicare
A provider enrolled in PECOS can bill Medicare on day one and still be out of network with every Medicare Advantage plan in town. Here is how MA credentialing actually works, why the timelines differ, how the preclusion list fits in, and the sequence that gets a new provider paid by MA plans without a gap.
HHS Restructuring, a New Secretary and the Medicaid Budget Fight: What to Watch
In ten weeks, HHS got a new Secretary, the House passed a budget resolution that points at Medicaid, and on March 27, 2025 HHS announced a plan to cut about 20,000 positions and fold 28 divisions into 15. Here is what happened, what it does and does not change for a practice, and what to watch.
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