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 Calculate Days in AR and What the Number Actually Tells You
Days in accounts receivable is the most quoted billing metric and the most misread. Here is the formula, the two ways practices distort it, the ranges we see for independent practices by specialty, and how to split it by payer and aging bucket so it points at something you can fix.
The January Claim Edit Tune-Up: Fee Schedules, NCCI Edits and Payer Resets
Every January the billing system runs on last year's fee schedules, last quarter's NCCI edits and payer policies that quietly reset on the first. Here is the tune-up we run in the first two weeks of the year, with the reports that show whether it worked.
WISeR Prior Authorization Starts in Six States: What to Submit, When and to Whom
Traditional Medicare now requires prior authorization for a list of services in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Requests are accepted from January 5 and apply to dates of service on or after January 15. Here is the practical setup.
The CY 2026 Physician Fee Schedule Is Live: What Changes on Your January Remits
The 2026 Medicare fee schedule took effect January 1 with two conversion factors, a 2.5 percent efficiency adjustment on procedural work and a flat rate for skin substitutes. Here is what to check when the first remits of the year arrive.
What Is a Clean Claim Rate and How to Measure It in Your Practice
A clean claim rate tells you how many claims pay on the first pass without anyone touching them again. Here is how we define it, how to pull it from your practice management system, what a good number looks like and the five fixes that move it.
Credentialing Before January: Network Checks, CAQH, Revalidation and New Plans
January brings new plans, terminated plans, new providers and payer contract changes at the same time. Here is the credentialing checklist we run in the last days of the year and the first days of January so that no provider is out of network or out of revalidation when the January claims go out.
Fee Schedules and CPT 2026: What to Load and Test Before the First January Claim
CPT 2026 takes effect January 1 with 288 new codes, 84 deletions and 46 revisions. The Medicare conversion factor, the corrected skin substitute rate, the OPPS update and the 2026 Part B deductible all change the same day. Here is the December checklist we run so the first January claims go out clean.
ACA Credits End December 31 and MA Plans Close: Patient Outreach Before January
Unless Congress acts, the enhanced marketplace premium tax credits expire on December 31, 2025, and millions of Medicare Advantage members are in plans that end the same day. Both mean coverage changes at your front desk in January. Here is the outreach plan the practices we work with are running now.
WISeR Starts January 1: Medicare Prior Authorization Comes to Six States
The WISeR model brings prior authorization to traditional Medicare for the first time at scale, in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, starting January 1, 2026. Skin substitutes, nerve stimulators, epidural steroid injections and knee arthroscopy are on the list. Here is how the workflow changes.
Page 8 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.