HCC V28 coding protects internal medicine risk scores only when every chronic condition is documented with MEAT support and V28-level specificity, because CMS removed more than 2,000 diagnosis codes from payment and constrained the coefficients that once rewarded complexity. With payment year 2026 r...

Yes, medical vs vision billing for optometrists is costing most eye care groups revenue they have already earned. When diabetic exams, glaucoma monitoring, dry eye care, and acute visits are billed to vision plans, the group collects a flat routine fee instead of a medical reimbursement, leaves diag...

Multi-provider OBGYN groups are leaving generalist billing vendors in 2026 because global maternity episodes, mid-pregnancy payer changes, and rising commercial audits now penalize billing logic built for single-encounter specialties. However, the shift is rarely about responsiveness or service comp...

Yes, vision vs medical plan crossover is costing most optometry groups real revenue. When an exam with a medical diagnosis is billed to a vision plan, the group collects a flat routine fee instead of a medical reimbursement that can be two to three times higher. When a routine exam is billed to a me...

When weighing 90460 vs 90471, pediatric groups should bill CPT 90460 when a physician or qualified health professional counsels the family on a vaccine for a patient through age 18, and CPT 90471 when no qualifying counseling occurs or the patient is 19 or older. Consequently, that single decision d...

Yes. For most multi-location optometry groups, the proposed rule would reduce Medicare revenue in 2027, and the conversion factor cut is the smallest piece of it. CMS proposed lowering the non-QP conversion factor to $32.84, down 1.68% from $33.40 in 2026. The bigger risk comes from three policy cha...

Global maternity billing hides revenue loss because your practice delivers up to ten months of care before a single claim is filed, so leakage never appears as a denial, an AR balance, or a variance alert. For multi-provider OB-GYN groups, that blind spot sits inside the highest-value service line i...

Optometry prior authorization usually fails at the front desk, not in the exam lane. It breaks when a scheduler books a medical eye visit as a routine vision exam, accepts a red-white-and-blue Medicare card from a patient who is actually on a Medicare Advantage plan, or verifies the vision plan whil...

A dermatology billing partner should guarantee at least a 97% clean claim rate measured at payer acceptance, and that guarantee only means something when the contract also ties it to First-Pass Yield and Net Collection Ratio. On its own, the clean claim rate is the easiest number in revenue cycle ma...

Your PDGM reimbursement fell because CMS’s CY 2026 recalibration redistributes payment value across all 432 case-mix groups in a budget-neutral way — a margin event that shows up on your P&L before it ever shows up in a coding audit. PDGM Reimbursement Decline: A Margin Problem, Not a Docu...