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.
Billing for NPs and PAs: The 85% Rule and How to Maximize Reimbursement
When a nurse practitioner or PA bills under their own NPI, Medicare pays 85% of the physician rate. Here is when that 15% haircut applies, when incident-to or split/shared can recover it, and how to stay compliant.
Modifier 26 vs. TC: Billing the Professional and Technical Components Correctly
Split-billable services like X-rays and EKGs have two halves — the read and the machine. Bill both when you only did one and you invite denials or takebacks. Here is how modifiers 26 and TC work, and when neither applies.
Patient Collections in the High-Deductible Era: A Practical Playbook
Patient balances now make up 30–40% of many practices’ revenue — and more than half of what you bill patients is at risk of never being paid. Here is how to collect more, sooner, without wrecking the patient relationship.
The Medicare Appeals Process: All 5 Levels and Their 2026 Deadlines
A denied Medicare claim is not the end — it is the start of a five-level appeal process. Miss a deadline and you forfeit the money. Here is each level, the filing window, and the 2026 dollar thresholds.
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.
Charge Capture: How to Stop Leaving 3–5% of Revenue on the Table
Missed and mis-coded charges quietly drain 3–5% of net revenue at a typical organization — six figures a year for many practices. Here is why charges slip through and a practical system to capture every one.
Anesthesia Billing Basics: Base Units, Time Units and the Modifiers That Set Your Pay
Anesthesia does not bill like the rest of medicine — it runs on a units-times-conversion-factor formula and a set of payment modifiers that can cut reimbursement in half. Here is how the math and the modifiers work.
CPT 2026 Code Changes: 418 Updates Your Practice Needs to Know
The 2026 CPT code set brought 288 new codes, 84 deletions, and 46 revisions — plus a full rebuild of lower-extremity revascularization and the first AI-service codes. Here is what changed and how to prepare.
Medical Necessity Denials and the ABN: The GA, GZ, GX and GY Modifiers Explained
When Medicare is likely to deny for medical necessity, the Advance Beneficiary Notice decides who pays. Get the ABN and its modifiers right and you protect revenue; get them wrong and you eat the cost. Here is the definitive guide.
Coordination of Benefits Denials: How to Fix and Prevent the CO-22 Trap
COB denials — led by code CO-22 — can be 10–20% of all rejections, and they stall cash on claims you have already earned. Here is why they happen, how to resolve them fast, and how to stop them at registration.
HCC Coding & Risk Adjustment: Why RAF Scores Drive Value-Based Revenue
Under Medicare Advantage and value-based contracts, your documentation sets the payment. With the V28 model now fully in effect, sloppy diagnosis capture quietly shrinks revenue. Here is how HCCs, RAF, and MEAT work.
ICD-10-CM 2026 Updates: 487 New Codes and What Your Coders Must Know
The FY2026 ICD-10-CM update added 487 new codes — nearly double last year — effective October 1, 2025. Here are the biggest changes, the chapters most affected, and how to update your practice before denials pile up.
