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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Denial Trends After the January 2026 Payer Changes: What Q1 Remits Are Showing
Three months of 2026 remittances are enough to see which January changes turned into denials. We walk through the CARC codes that rose this quarter, the payer behaviors behind them, and the fixes that stop each category before April claims go out.
HIMSS26 in Las Vegas: What Independent Practices Should Actually Watch
The HIMSS Global Health Conference runs March 9 to 12, 2026 at the Venetian in Las Vegas, with more than 600 sessions on AI, cybersecurity and interoperability. Most of it is aimed at health systems. Here is what will reach a ten-provider practice within a year, and how to vet the vendors who come back from it.
Behavioral Health Integration Billing: 99484, CoCM, G0323 and the 2026 Add-Ons
Most primary care offices screen for depression and then have nowhere to send the positives. Behavioral health integration billing pays for doing the follow-up in-house. We walk through 99484, the collaborative care codes, G0323 for psychologists and social workers, and the APCM add-ons that arrived in January 2026.
Medicare Advantage vs Original Medicare Billing: The Differences for Practices
More than half of Medicare patients now arrive with a plan card rather than a red, white and blue one, and the billing rules change with it. We lay out the Medicare Advantage vs Original Medicare billing differences a practice feels: who to bill, authorizations, rates, timely filing and appeals.
Prior Authorization Software: What the 2027 API Deadlines Do and Do Not Fix
Every vendor pitch this year mentions the January 1, 2027 deadline for payer prior authorization APIs. The deadline is real and useful, but it covers only some payers and depends on your EHR. Here is what the APIs will do, what they will not, and the questions to ask before signing.
Medical Billing Terms Every Physician Should Know: A Working Glossary
Physicians sign off on billing reports full of words they were never taught. This glossary covers the medical billing terms every physician should know, grouped by where they appear in the revenue cycle, with the number to watch next to each and a note on how each term gets misused.
2027 MA Advance Notice: What the Audio-Only Change Means for Practices
CMS released the 2027 Medicare Advantage and Part D Advance Notice on January 26, 2026, proposing a nearly flat payment update and excluding diagnoses from audio-only visits and unlinked chart reviews from risk adjustment. Here is why practices, not just plans, should read it.
Prior Authorization Service Levels to Hold Payers to in 2026, by Payer Type
Between CMS-0057-F, the ERISA claims regulation, state laws and the insurers' voluntary pledge, most payers now owe you a decision within a defined window and a specific reason for a denial. Here is the service level table we use, and how to track whether each plan meets it.
Prior Authorization Clocks Start January 1: 72 Hours, 7 Days, a Written Reason
CMS-0057-F now requires Medicare Advantage, Medicaid and CHIP plans to decide urgent prior authorization requests within 72 hours and standard requests within seven calendar days, and to give a specific denial reason. Here is what changed on January 1 and how to hold payers to it.
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