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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Medicaid Work Requirements Arrive January 2027: Eligibility Outreach Starts Now
The 2025 reconciliation law requires expansion states to apply an 80-hour monthly work requirement to most adults aged 19 to 64 by January 1, 2027, with a federal rule due June 1, 2026 and six-month renewals to follow. Here is what states are doing this spring and how a practice protects its Medicaid revenue.
Building a Denial Work Queue That Pays: Sort by Dollars, Deadline and Fix Type
Most billing teams work denials oldest first, which is how $14 balances get touched while $2,400 authorization denials pass their appeal deadline. Here is how we build a denial work queue sorted by expected payment, days to deadline and fix type, with the fields, the scoring and the numbers to watch.
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.
Patient Balance Workflows for 2026: Statements, Payment Plans and the Stop Point
Patient balances are now a large share of practice AR, and most practices work them badly: late first statements, no text option, no payment plan rules and no defined stop point. Here is the workflow we set up, with timing, dollar thresholds and the reports that show whether it is working.
Medicare Participation Status: Par, Non-Par and Opt-Out Billing Rules Explained
A physician's Medicare participation status decides how much the practice is paid, who Medicare sends the check to and what the patient can be billed. Here is how participating, non-participating and opt-out actually work, with a 99214 worked example, the limiting charge math and the deadlines.
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.
The Marketplace 90-Day Grace Period: Why Claims Pend in Months Two and Three
Eligibility says active, the claim goes out, and nothing comes back for weeks. The patient is in the Marketplace 90-day grace period, and the plan may hold your claim until the premium is paid or coverage is cancelled retroactively. We explain the rule, why 2026 is a bad year for it, and how to protect the practice.
The HIPAA Security Rule Update Is Still Pending: What to Do While You Wait
HHS proposed the biggest rewrite of the HIPAA Security Rule in two decades in January 2025. As of March 2026 there is still no final rule. Here is what the proposal would require, why waiting for it is a mistake, and the seven steps a practice can take this spring that will be needed under any version.
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.
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