Compliance & Regulations
Every article we've published on Compliance & Regulations.
MIPS in 2026: The Performance Threshold, Category Weights and Payment Risk
MIPS can swing your Medicare payments up or down by up to 9%. For 2026 the 75-point threshold holds, the four categories keep their weights, and MVPs keep expanding. Here is what you need to hit — and avoid.
Incident-To Billing in 2026: The Rules, the Risks, and the New Virtual-Supervision Change
Incident-to pays NP and PA services at 100% instead of 85% — but only when every condition is met, and it is a top audit target. Here are the rules, the 2026 virtual-supervision update, and how to stay clean.
Medicare Secondary Payer (MSP): How to Get the Payment Order Right
When Medicare is not primary, billing it first is an instant denial — and getting MSP wrong is a compliance risk. Here are the common scenarios, the 20-employee rule, and how to bill secondary claims cleanly.
The 60-Day Overpayment Rule: How to Handle Credit Balances Without False Claims Risk
A Medicare overpayment you sit on can become a False Claims Act problem. Here is how the 60-day rule works, the 2025 update that gives you time to investigate, and how to manage credit balances cleanly.
Telehealth Billing in 2026: Where the Flexibilities Stand and How to Code It
The telehealth cliff got pushed to the end of 2027 — but not everything is permanent, and POS coding still trips practices up. Here is exactly what is extended, what is permanent, and how to bill it right in 2026.
The Two-Midnight Rule: Inpatient vs. Observation, and Why It Now Binds Medicare Advantage
Get the two-midnight decision wrong and a short inpatient stay becomes a denied Part A claim. Here is how the rule works, how Condition Code 44 saves the stay, and why it now applies to Medicare Advantage plans too.
The No Surprises Act in 2026: What Your Practice Must Do to Stay Compliant
Good Faith Estimates, the $400 dispute rule, and a friendlier IDR process in 2026 — here is exactly what the No Surprises Act requires of your practice this year, and how to avoid costly missteps.
Prior Authorization in 2026: The New Federal Rules Every Practice Should Use
Faster decisions, mandatory denial reasons, and public payer scorecards arrive in 2026 under CMS-0057-F — with electronic prior authorization APIs coming in 2027. Here is what changes and how to turn it to your advantage.
