Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Credentialing a Provider Who Starts in Q1: A Plan When You Are Already Late
A physician starts April 1 and the enrollment file was opened last week. It happens every winter. Here is how we triage the payer list, what Medicare allows retroactively, how to schedule around pending plans, and the claim-holding discipline that keeps timely filing intact.
Credentialing Renewals, CAQH Attestations and Revalidations in December
Licenses, DEA registrations, CAQH attestations, Medicare revalidations and payer recredentialing all expire on their own calendars, and several cluster at year-end. Here is the December review we run, the intervals for each item, and the failures that stop payment for a whole provider without warning.
After the Election: Five Health Policy Items Practices Are Watching Now
The November 5 election is over and the practical questions for practices are the ones that were pending before it: the December 31 telehealth expiration, the 2.83% Medicare cut, ACA subsidy timing, Medicare Advantage disruption during open enrollment, and cybersecurity rules. Here is what is decided and what is not.
How to Run a Fourth-Quarter Denial Review, Including the Timely Filing Check
A fourth-quarter denial review has one purpose: recover what can still be recovered in 2024 and stop the same denials from following you into January. Here is the report set, the buckets by cause, the timely filing audit that belongs in the same week, a worked example, and how to turn the findings into three fixes.
FTC Noncompete Rule Set Aside: What It Means for Physician Employment Agreements
On August 20, a federal judge in Texas set aside the FTC's nationwide ban on noncompete agreements, two weeks before it would have taken effect. For medical practices, that means noncompetes remain a matter of state law. Here is what changed, what did not, and the departure checklist that matters more.
When a Local Hospital System Is in Trouble: Protecting Referrals and Payer Mix
Steward Health Care filed for Chapter 11 on May 6 with 31 hospitals and more than $9 billion in liabilities. For independent practices nearby, a hospital system's collapse changes where patients go, which contracts pay and who answers the phone. Here is how to measure the exposure and protect the practice.
Credentialing a New Practice Location: What Payers Need and How Long It Takes
Opening a second office looks like a real estate problem until the first claims from the new address deny. Here is what each payer type requires when a group adds a location, the order to do it in, the forms involved, a dated example, and the claim holds that keep new-location claims from becoming write-offs.
Switching Clearinghouses After the Outage: How to Do It, and When Not To
Change Healthcare began reconnecting its claims network the week of March 18, and practices are now deciding whether to switch back, stay with a new vendor or run both. Here is what a clean clearinghouse migration involves, the enrollment steps that take the longest, and the cases where switching is the wrong call.
Building a Credentialing Revalidation Calendar That Outlives Your Coordinator
A lapsed revalidation stops every claim for a provider, usually with no warning. Here is how to build the one document that prevents it: every provider, every payer, every date, with realistic lead times, the fields it must carry, and the monthly routine that keeps it alive after the person who built it leaves.
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