Why Is Medicare Advantage Downcoding Your Neurology EEG Claims?

Medicare Advantage EEG downcoding happens when plans downcode neurology EEG claims because their algorithmic review systems scan interpretation reports for specific structured language, not clinical judgment. When a report is written the way physicians are trained to write it, in clinical narrative, the algorithm cannot find what it is looking for, so it defaults to […]

Medical Scribing Services for Physician Groups

Medical Scribing Services solve a problem most physician groups don’t realize is a revenue problem: notes that get finished thin, late, or after-hours because providers can’t document and see patients at the same pace. For a solo doctor, that’s a personal time crunch. Across a multi-provider group, it’s a compounding billing gap, since a thinner […]

How to Choose the Best Orthopedic Billing Services?

To choose the best orthopedic billing services, look for a partner staffed by certified orthopedic coders who track global surgery periods claim by claim, apply modifiers correctly the first time, report denial rates and days-in-AR every month, and price their service as a percentage of what they actually collect for you. A generalist billing vendor […]

Is Your Family Practice Reimbursement Model on the Winning or Losing Side of CY2026’s Payment Split?

Family Practice Reimbursement is shifting fast under CY2026’s split payment structure. Most multi-provider Family Practice Billing Services groups land on the winning side of CY2026’s payment split by structure, not by luck: the bulk of family practice revenue runs through E/M and chronic care codes that CMS specifically exempted from this year’s biggest cut. But […]

What Makes Ophthalmology Billing So Complex to Manage?

Ophthalmology billing is complex because it runs on two coding systems at once (Eye codes and E/M codes), stacks a 92-day global surgical period on top of one of Medicare’s highest-volume procedures, and demands drug-level accuracy for injectable medications that cost more per dose than a typical office visit. A federal watchdog just flagged $124 […]

Is Your Orthopedic AR Ready to Close Out Before Year-End?

Probably not, and that’s normal. Most orthopedic groups and multi-surgeon facilities carry a meaningful chunk of orthopedic AR sitting past 90 and 120 days heading into Q4, largely because joint and spine procedures carry 90-day global billing periods, implant documentation delays, and workers’ comp cases that age slower than routine claims. The real question isn’t […]

What Replaced G0511? A Primary Care Guide to CY2026 APCM

G0511 was replaced by two paths: RHCs and FQHCs now either bill individual CPT and HCPCS care management codes per service, or bill the three-tier Advanced Primary Care Management (APCM) codes — G0556, G0557, and G0558 — introduced for CY2025 and expanded further under CY2026 rules. What Was G0511, and Why Did CMS Retire It […]

Are Denial Write-Offs Quietly Eating Your Facility’s EBITDA?

Yes. For most multi-provider practices and facilities, denial write-offs are one of the largest hidden drains on EBITDA, often erasing 3% to 5% of net patient revenue every year. Unlike a denied claim that gets reworked and paid, a write-off is money your facility has permanently given up, and it rarely shows up as a […]

Is Graft Application Billing Keeping Up With the CTP Rule Change?

Graft application billing has not kept pace with the CTP rule change for most wound care groups, and the gap shows up as underpayment on every claim still coded and documented the old way. CMS restructured how cellular and tissue-based products (CTPs) are paid under the CY 2026 Physician Fee Schedule Final Rule, moving most […]

Which New Procedures Are Covered Under the CY2026 ASC Payment Rule?

The CY2026 ASC Payment Rule adds 289 procedures to the ASC Covered Procedures List through revised coverage criteria, plus 271 additional codes carried over as CMS phases out the Inpatient Only List, bringing the total number of newly ASC-eligible procedures to more than 500. What Changed in the CY2026 ASC Payment Rule? CMS finalized the […]

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