Specialities
Hospitalists billing in Ohio are operating under more Medicare Advantage audit pressure than at any point in the specialty’s history. Ohio has approximately 2.5 million Medicare beneficiaries — about one in five Ohioans aged 65 or older — and MA enrollment across the state spans 212 plans from UnitedHealthcare, Humana, Aetna, Anthem Blue Cross and Blue […]
Orthopedic billing services in Michigan for providers are navigating a market that is harder to bill correctly in 2026 than at any point in recent history. The CY 2026 Physician Fee Schedule Final Rule (CMS-1832-F) applied a −2.5% efficiency adjustment to orthopedic surgical work RVUs. Blue Cross Blue Shield of Michigan — the state’s dominant […]
Coding errors are the single largest driver of denied and underpaid claims in ambulatory surgery center billing—and when it comes to ASC Revenue in Illinois, the impact is even more pronounced than in most states. Illinois’s fragmented Medicaid managed care landscape, combined with the January 2026 MMAI-to-FIDE-SNP transition that shifted thousands of dual-eligible patients into […]
Wound care billing services in California have never carried more financial risk than they do in 2026. Noridian Healthcare Solutions — the Medicare Administrative Contractor covering California — is the same organization CMS selected as the nationwide Supplemental Medical Review Contractor, actively auditing wound care surgical supplies across the country. The CY 2026 Physician Fee […]
Wound care billing services in Pennsylvania are navigating one of the most demanding reimbursement environments in the country right now. Pennsylvania sits under Novitas Solutions’ JH/JL MAC jurisdiction — and Novitas is actively conducting Targeted, Probe and Educate audits on skin substitute claims. The CY 2026 Physician Fee Schedule Final Rule (CMS-1832-F) reset non-biological skin […]
Yes — and most do not know exactly how much. ICU revenue in California is among the most undercaptured billing categories in internal medicine, driven by three structural failures that repeat on every billing cycle: critical care time documentation that does not satisfy CPT 99291/99292 requirements, Medicare Advantage prior authorization denials on ICU-adjacent services, and the bundling […]
The Request for Anticipated Payment (RAP) is gone — replaced by the Notice of Admission (NOA) — and the 2026 PDGM rate recalibration has arrived simultaneously. Together, these two CMS policy shifts are reshaping HomeHealth PDGM revenue in Texas in ways that most agencies have not fully mapped to their billing workflows. The agencies that understand exactly […]
Anesthesia billing services in Georgia have never been more complex than they are right now. The CY 2026 Physician Fee Schedule Final Rule (CMS-1832-F) changed the conversion factor structure. Palmetto GBA, Georgia’s Medicare Administrative Contractor, is scrutinizing modifier submissions more aggressively than ever. And Georgia’s commercial payer landscape — led by Blue Cross Blue Shield […]
Reconstructive claim denials in California are one of the most expensive and most preventable revenue losses in plastic surgery. Plastic surgery billing services in California face a payer environment that is more complex than in most states — commercial payers define the cosmetic-versus-reconstructive line differently from each other, Medi-Cal imposes coverage rules that differ by county health […]
Oregon orthopedic billing services are navigating a more demanding regulatory landscape in 2026 than any prior year — and the practices that haven’t updated their billing infrastructure to match it are losing revenue quietly on every case. The CY 2026 Physician Fee Schedule Final Rule (CMS-1832-F) applied a −2.5% efficiency adjustment to orthopedic surgical work […]
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