Billing insight that pays for itself.
Clear, current guidance on Medicare reimbursement, denials, credentialing and revenue cycle management — written by the team that bills for practices across all 50 states.
Transitional Care Management Billing: How to Capture 99495 and 99496
TCM is one of Medicare’s best-paying care-coordination services — and one of the most commonly botched. Miss the 2-business-day call and the whole claim is gone. Here is how to bill 99495 and 99496 correctly.
Medicare Annual Wellness Visit Billing: G0438, G0439 and How to Do It Right
The AWV is fully covered, well paid, and pairs beautifully with a same-day problem visit — yet practices routinely under-bill it or fail the documentation. Here is the complete 2026 coding and compliance guide.
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.
Modifier 50: How to Bill Bilateral Procedures for the Full 150%
When a procedure is done on both sides, modifier 50 can pay 150% — but only for the right codes, and some payers reject it entirely in favor of RT/LT. Here is how the bilateral indicators work and how to bill each one.
Claim Rejection vs. Denial: The Difference That Decides How Fast You Get Paid
Rejections and denials look similar but are handled completely differently — and confusing them wastes days and appeals you didn’t need. Here is how to tell them apart and route each one correctly.
Advanced Primary Care Management (APCM): Billing G0556, G0557 and G0558
APCM is Medicare’s newest care-management benefit — no monthly time tracking, just a per-patient monthly payment tiered by complexity. Here are the 2026 rates, the 13 service elements, and how it stacks with RPM.
Split/Shared Visit Billing in 2026: How to Define the Substantive Portion
For 2026, CMS finalized that the "substantive portion" of a split/shared visit can be based on time OR medical decision-making. Here is what that means for facility billing and how to document it correctly.
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.
New vs. Established Patient: The 3-Year Rule That Changes What You Get Paid
New-patient E/M codes pay more than established — but bill "new" when the rules say "established" and you invite recoupment. Here is exactly how the 3-year rule, specialty, and group practice decide the status.
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 6 Medical Billing KPIs Every Practice Should Track (With 2025 Benchmarks)
You cannot fix what you do not measure. These six revenue-cycle KPIs — with the benchmarks that separate high performers from the pack — tell you exactly where your practice is winning and where it is bleeding.
