Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Bill Newborn Claims: The 30-Day Enrollment Window and Month-Two Denials
Newborn claims pay in month one and deny in month two because nobody added the baby to the plan. We walk through the three coverage clocks that start at delivery, how to bill under the mother's ID, the CARC codes that follow, and the front desk script that stops the problem.
AR Clean-Up Before Q4: A Six-Week Plan for Aging Claims and Unapplied Cash
Between now and the end of September, claims from the first half of the year pass the point where most commercial timely filing limits expire. A six-week clean-up recovers what can be recovered and writes off the rest with a reason attached. Here is the plan we run, week by week, with the numbers to check.
Medicare 2026-2027 Flu Vaccine Payment Allowances: Codes, Rates, Roster Billing
CMS posted the Medicare Part B payment allowances for the 2026-2027 flu season on July 31, effective August 1, 2026. High-dose, adjuvanted and recombinant vaccines all land at $122.52 this year. Here are the codes, the rates, the administration rules and the flu clinic setup we recommend before September.
Talking to Patients About 2027 Coverage Changes: Scripts, Letters and Timing
Marketplace insurers want a 15 percent median premium increase for 2027, Medicaid expansion adults face six-month renewals and work requirements, and deductibles reset in January. Patients will ask your staff what to do. Here is what to say, when to say it, and the four letters to have ready.
What to Include in an Eligibility Verification Workflow for Your Front Desk
Eligibility denials are the easiest denials to prevent and among the most common. A workflow that checks the right things at the right three moments, records what was checked, and gives the front desk a script for failures removes most of them. Here is what to include.
Stark Law and Anti-Kickback Statute for Practice Owners: What Needs a Lawyer
Most independent practices trip over Stark and the Anti-Kickback Statute in ordinary arrangements: a lease with a lab, a medical director stipend, a free interface, a waived copay. We explain what each law covers, which everyday deals are the risky ones, and when to stop and call counsel.
How to Bill a Sports Physical: Back-to-School Visits, Codes and Payer Rules
August fills the schedule with sports physicals, well-child visits and vaccine catch-up. Most of the write-offs we see in September come from mixing those three up on the claim. Here is how to bill a sports physical correctly, when to combine it with the annual well visit, and what to tell parents at check-in.
OSF Healthcare $552,250 Settlement: HIPAA Breach Notification Deadlines Matter
On July 29, 2026, OCR announced a $552,250 settlement with OSF Healthcare System over a 2021 ransomware attack affecting 53,907 people. The findings were a missing risk analysis and late breach notifications. We explain the timeline, the notification deadlines and what a small practice should check.
Medicaid Work Requirement Rule Takes Effect July 31: A Front-Desk Guide
CMS's June 1, 2026 interim final rule on Medicaid work requirements takes effect July 31. States must finish initial outreach by August 31, run the 80-hour test by January 1, 2027, and move expansion adults to six-month renewals. Here is the timeline and the front-desk workflow.
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