Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Advance Care Planning Codes 99497 and 99498: Documentation, Time and the AWV
Advance care planning is one of the few conversations Medicare pays for separately, and most practices either never bill it or bill it without the time and content the codes require. Here is how 99497 and 99498 work, the 16-minute threshold, modifier 33 with the wellness visit, and a note template.
UnitedHealthcare April 2026 Bulletin: PC/TC Edits and Genetic Test Authorization
UnitedHealthcare's April 2026 bulletin brings a PC/TC policy change for radiology billed with an E/M from April 1, new genetic and molecular codes needing prior authorization for commercial and exchange plans, and Gold Card list changes. Here is what to check in your charge master and authorization lists.
CMS Finalizes 2027 Medicare Advantage Rates: What Practices Should Take From It
On April 6, 2026 CMS released the CY 2027 Medicare Advantage Rate Announcement: a 2.48 percent net payment increase, up sharply from the 0.09 percent advance notice, and a decision to exclude diagnoses from audio-only visits and unlinked chart reviews from risk adjustment. What it means for practices.
Claim Scrubber Rules Worth Adding, Who Owns Them and the Monthly Review
Most practices run their claim scrubber on the vendor's default edits and wonder why the same denials keep coming back. Here are the custom claim scrubber rules worth adding, how to build one from a denial, who should own the rule set and the monthly review that keeps it from rotting.
Prior Authorization Appeals Under the New 7-Day and 72-Hour Timeframes
Since January 1, 2026 Medicare Advantage and Medicaid managed care plans must decide standard prior authorization requests in seven days, expedited requests in 72 hours, and state a specific reason for every denial. Here is how to build an appeal around that reason, the deadlines on both sides, and a letter that works.
WISeR at Three Months: Prior Authorization in Traditional Medicare in Six States
Since January 1, 2026 the CMS WISeR model has applied prior authorization to a short list of services in traditional Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Here is how it works, what practices in those states have run into so far, and what to watch if you are elsewhere.
Prolonged Services Coding: 99417 vs G2212, Time Thresholds and Documentation
A 62-minute follow-up visit is worth more than a 99215, but only if you know which prolonged code the payer accepts and at what minute it starts. We explain 99417 and Medicare's G2212, the 55, 69, 75 and 89 minute thresholds, the time statement that survives an audit, and the mistakes that get these add-ons denied.
Unspecified Diagnosis Codes, Laterality and Seventh Characters: Avoiding Denials
The diagnosis code is the part of the claim physicians control most and check least. When an unspecified code is acceptable and when it will deny, how laterality and the seventh character work, the codes office practices get wrong most often, and the documentation phrases that let a coder pick the specific code.
Payers Must Post Prior Authorization Metrics by March 31, 2026: How to Read Them
Under CMS-0057-F, Medicare Advantage, Medicaid managed care, CHIP and exchange plans must publish their 2025 prior authorization approval, denial, appeal and turnaround numbers by March 31, 2026. Here is where to find them, what they can and cannot tell you, and how to use them in appeals and contract talks.
Page 6 of 12 · 105 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.