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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
CMS Revised the ABN Form on March 13, 2026: When to Issue It and Which Modifier
A revised Advance Beneficiary Notice of Noncoverage, Form CMS-R-131, was approved on March 13, 2026 and must be in use by May 12. What changed, when an ABN is required, when it is prohibited, how to fill it in, and the GA, GX, GY and GZ modifiers that tell Medicare who pays if the claim denies.
Medicare Preventive Services Beyond the Wellness Visit: Screening and Limits
Most primary care offices bill the annual wellness visit and stop. Medicare also pays separately for alcohol screening, depression screening, tobacco counseling, cardiovascular and obesity counseling and a twice-yearly risk assessment, each with its own frequency limit. Here is the list, the rules and a worked visit.
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.
First-Quarter 2026 Revenue Review: The Eight Numbers to Pull Before April Starts
March is when the January payer and fee schedule changes show up in real remittances. Here are the eight numbers we pull for every practice at the end of Q1, how to read each one against the 2026 Medicare conversion factor and the January deductible reset, and what a bad number usually means.
MIPS 2025 Data Submission Closes March 31, 2026: A Four-Week Checklist
The submission window for the 2025 MIPS performance year closes at 8 pm Eastern on March 31, 2026. Here is what to verify in the QPP portal this month, the numbers that decide whether you clear the 75-point threshold, and the mistakes that cost practices a 9 percent cut in 2027.
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.
Incident-To Billing Requirements: The Rules, the 85 Percent Math and Audit Traps
Billing a nurse practitioner's visit under the physician's NPI pays 15 percent more from Medicare and is legal only under specific conditions. We lay out the incident-to billing requirements, work the math on when it is worth it, and describe the four failures that turn a routine visit into an overpayment.
How to Bill APCM in 2026: G0556 to G0558 and the New Behavioral Health Add-Ons
Advanced Primary Care Management pays a monthly amount per Medicare patient with no time tracking. For 2026, CMS added three add-on codes for behavioral health integration and collaborative care. Here is how the codes fit together, what must be documented, and what cannot be billed alongside them.
MIPS Payment Adjustments on 2026 Medicare Remits: CARC 144, 237 and Remark N807
Since January 1, every Medicare Part B remit carries the result of your 2024 MIPS score, as a small increase or a cut of up to nine percent. We explain how the 2026 MIPS payment adjustment appears on the remit, how to verify it against your final score, and what to do if the numbers disagree.
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