{"id":30461,"date":"2026-06-24T19:00:50","date_gmt":"2026-06-24T13:30:50","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=30461"},"modified":"2026-06-24T19:06:49","modified_gmt":"2026-06-24T13:36:49","slug":"mid-year-billing-cleanup-what-fixed-before-q3","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/mid-year-billing-cleanup-what-fixed-before-q3\/","title":{"rendered":"Mid-Year Billing Cleanup: What Needs to Be Fixed Before Q3?"},"content":{"rendered":"<p><strong>A Mid-Year Billing Cleanup<\/strong> is a structured audit of your revenue cycle performed at the halfway point of the year to fix claim errors, reconcile unapplied payments, and stop revenue leakage before Q3 makes it worse.<\/p>\r\n<p>For physician groups and specialty practices, completing this review in June \u2014 not December \u2014 is what separates practices that hit annual collection targets from those buried in year-end write-offs. In June 2026, there is no better time to run this review.<\/p>\r\n<p>The CY 2026 Physician Fee Schedule has been active since January 1 with two new conversion factors, the FY2026 OIG Work Plan is actively adding new audit targets monthly, and most practices are now five to six months into billing patterns they have never stress-tested. The gaps that formed in Q1 and Q2 are still recoverable \u2014 but only if you act now.<\/p>\r\n<h2>1. Audit Your AR Aging Report \u2014 Before the 90-Day Cliff<\/h2>\r\n<p>The most damaging thing a billing team can do is ignore accounts receivable aging beyond 60 days. The probability of collecting on a claim drops sharply once it crosses 90 days, and most commercial payers follow the same patterns as Medicare.<\/p>\r\n<p><strong>Your Mid-Year Billing Cleanup<\/strong> should begin with a full AR aging report segmented by payer, provider, and CPT code bucket. Look for:<\/p>\r\n<ul>\r\n<li>Claims denied for missing prior authorizations that were never resubmitted<\/li>\r\n<li>Balances sitting in &#8216;pending&#8217; status with no follow-up date assigned<\/li>\r\n<li>Unapplied payments inflating your suspense account and distorting cash flow<\/li>\r\n<li>Duplicate billing entries that could trigger payer audits or RAC review requests<\/li>\r\n<\/ul>\r\n<p>If your practice is still managing AR aging in spreadsheets, that is an infrastructure problem your medical billing services partner should have resolved. Modern RCM platforms flag aging claims automatically \u2014 if yours does not, the mid-year point is the right time to escalate that conversation.<\/p>\r\n<h2>2. Reconcile Your CY 2026 Fee Schedule Crosswalk<\/h2>\r\n<p>This is the most overlooked step in any mid-year review \u2014 and in 2026 it is more critical than ever. Effective January 1, 2026, CMS implemented <strong>two separate conversion factors<\/strong> for the first time: $33.57 for qualifying APM participants and $33.40 for non-qualifying APM participants, representing increases of 3.77% and 3.26% respectively from the CY 2025 rate of $32.35.<\/p>\r\n<p>If your fee schedule crosswalk has not been updated to reflect these CY 2026 conversion factors, your payer variance reports are producing inaccurate underpayment data \u2014 and every shortfall you miss now becomes a write-off by December.<\/p>\r\n<p>The CY 2026 PFS Final Rule (published October 31, 2025, effective January 1, 2026) is available directly at the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\">CMS Physician Fee Schedule page<\/a>. Practices working with a qualified revenue integrity partner should have this crosswalk updated automatically.<\/p>\r\n<p>This step also matters because the CY 2026 rule introduced a 2.5% efficiency adjustment to work RVUs for non-time-based services. If your internal benchmarks have not accounted for this adjustment, your collections-to-expected ratio will be off, and you may be writing off legitimate underpayments as &#8216;contractual adjustments.&#8217;<\/p>\r\n<h2>3. Identify Revenue Leakage by CPT Code \u2014 Not Just Denial Category<\/h2>\r\n<p>Most practices look at denial rates. Fewer look at what was never billed in the first place. Revenue leakage in specialty practices routinely occurs at the documentation stage, before a claim is ever submitted.<\/p>\r\n<p>CMS updates its National Correct Coding Initiative (NCCI) edits quarterly. The Q2 2026 NCCI update (effective April 1, 2026) introduced new bundling restrictions affecting evaluation and management codes billed alongside certain procedure codes \u2014 with direct impact on orthopedics, pain management, and gastroenterology practices.<\/p>\r\n<p>The current NCCI Policy Manual is available at the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/national-correct-coding-initiative-ncci-edits\">CMS NCCI Edits page<\/a>. If your team has not audited coding against the Q2 2026 update, you may already have both a compliance exposure and a revenue gap forming simultaneously.<\/p>\r\n<p>A proper mid-year coding audit cross-references your top 20 billed CPT codes against current NCCI edits, MAC Local Coverage Determinations in your jurisdiction, and any payer-specific billing guidelines updated in 2026.<\/p>\r\n<h2>4. Reconcile Unapplied Payments and Clear Your Suspense Account<\/h2>\r\n<p>Unapplied payments are one of the most underreported sources of billing risk. When ERA payments are posted without matching to specific claims, they accumulate in suspense accounts \u2014 and practices often carry these balances for months without realizing it.<\/p>\r\n<p><strong>During your Mid-Year Billing Cleanup<\/strong>, reconcile every payment posted since January 1 against open claims. The goal is a zero-balance suspense account. Anything left unmatched after 30 days of review should be escalated to your RCM services provider for manual resolution.<\/p>\r\n<p>This step alone has recovered an average of $40,000\u2013$80,000 in found revenue for mid-sized specialty practices \u2014 revenue that was collected but never applied, quietly sitting in accounting limbo for months.<\/p>\r\n<h2>Reactive vs. Proactive Mid-Year Billing Cleanup: The Cost of Waiting<\/h2>\r\n<table style=\"width: 98.8775%;\" width=\"0\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\"><strong>Revenue Risk Area<\/strong><\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\"><strong>Reactive (Year-End Only)<\/strong><\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\"><strong>Proactive Mid-Year Billing Cleanup<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\">AR Aging Review<\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Caught too late; write-offs spike in Q4<\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\">Fixed in real time; DSO drops 15\u201320%<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Claim Denial Rate<\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Root causes go untreated for 6\u201312 months<\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\">Root-cause analysis closes denial loops by Q3<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Unapplied Payment Risk<\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Distorts cash flow and financial reporting<\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\">Reconciled mid-year; accurate P&amp;L picture<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\">CMS\/OIG Compliance Exposure<\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Audit-ready only at year-end \u2014 often too late<\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\">Ongoing; aligned with FY2026 OIG Work Plan<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\">CY 2026 PFS Fee Schedule Alignment<\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Variance reports unreliable if not updated<\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\">Crosswalk updated; underpayments caught early<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Revenue Recovery Potential<\/td>\r\n<td style=\"width: 32.8197%;\" width=\"208\">Minimal; collection window closes<\/td>\r\n<td style=\"width: 48.6903%;\" width=\"208\">$80K\u2013$200K+ recovered per audit cycle<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>5. Run a Modifier Compliance Audit Against the FY2026 OIG Work Plan<\/h2>\r\n<p>The OIG FY2026 Work Plan is actively expanding. As of June 2026, the OIG has added new audit projects targeting Medicare Advantage risk adjustment, Part B drug billing, and inpatient rehabilitation facility claims. Medicare Part B drug billing \u2014 including modifier compliance on injection and infusion claims \u2014 remains a consistent OIG focus area.<\/p>\r\n<p>The OIG Work Plan is updated monthly, and practices that monitor it proactively can anticipate audit targets before they become demand letters. The full active work plan is available at the <a href=\"https:\/\/oig.hhs.gov\/reports-and-publications\/workplan\/active-item-table.asp\">OIG Active Work Plan Items page<\/a>. Your mid-year modifier audit should specifically address:<\/p>\r\n<ul>\r\n<li>JW modifier (drug amount discarded) and JZ modifier (no drug discarded) \u2014 mandatory on all Part B drug claims since January 1, 2024, now in their third year of enforcement with active OIG monitoring<\/li>\r\n<li>Modifier 25 \u2014 if your practice bills this on more than 40\u201350% of procedure days, that ratio warrants a documentation review before a RAC auditor flags it<\/li>\r\n<li>Modifier KX \u2014 required on claims for services where medical necessity is established by a Local Coverage Determination; missing KX on applicable claims is an automated denial trigger<\/li>\r\n<\/ul>\r\n<p>A systematic modifier audit across H1 2026 claims is not optional at this point. It is the most direct protection against a demand letter arriving in Q4.<\/p>\r\n<h2>Is Your Practice Leaving Revenue on the Table Before Q3?<\/h2>\r\n<p>Most practices discover $80,000 to $200,000 in recoverable revenue during a structured mid-year audit \u2014 revenue that would have been written off by December. With CY 2026 fee schedule changes, new NCCI edits in effect since April, and the OIG Work Plan adding targets monthly, the mid-year window to fix H1 billing gaps is closing.<\/p>\r\n<p>Our team has conducted Mid-Year Billing Cleanup reviews across 20+ specialties in 40+ states, identifying coding errors, unapplied payments, and modifier compliance gaps that in-house teams consistently miss. We identify the gaps before they become permanent losses \u2014 with no commitment required to start.<\/p>\r\n<p><strong>Call: <\/strong><a href=\"tel:888-357-3226\">888-357-3226<\/a> | <strong>Email: <\/strong><a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a><\/p>\r\n<p>Or <a href=\"https:\/\/www.medicalbillersandcoders.com\/pricing\">review our medical billing and coding services and pricing options<\/a> to find the right fit for your specialty and practice size.<\/p>\r\n<h2>FAQs: Mid-Year Billing Cleanup<\/h2>\r\n\r\n<div class=\"schema-faq wp-block-yoast-faq-block\">\r\n<div id=\"faq-question-1782307483083\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\"><strong>Q1. How often should a practice perform a Mid-Year Billing Cleanup?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">At minimum, once at mid-year and once at year-end. High-volume specialty practices billing 500+ claims per month benefit from quarterly AR audits given the frequency of payer-specific rule updates and NCCI edit cycles.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1782307501761\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\"><strong>Q2. What does the CY 2026 conversion factor change mean for my practice?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">CMS now uses two separate conversion factors: $33.57 for qualifying APM participants and $33.40 for non-QPs \u2014 both increases from the 2025 rate of $32.35. If your fee schedule crosswalk has not been updated, you are benchmarking collections against the wrong rates and likely missing underpayments.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1782307512947\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\"><strong>Q3. Can our internal billing team handle a mid-year cleanup without outside help?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">Internal teams can handle AR aging review. But coding accuracy audits against Q2 2026 NCCI edits, MAC LCD compliance, and payer contract crosswalks typically require <a href=\"https:\/\/www.medicalbillersandcoders.com\/medical-billing-services.aspx\">specialized medical billing and coding service<\/a>s expertise that most in-house teams do not maintain.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1782307522025\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\"><strong>Q4. How does a mid-year billing review protect us from OIG and RAC audits?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">OIG and RAC auditors target statistical patterns \u2014 elevated Modifier 25 rates, missing JW\/JZ modifiers, and unusual CPT-to-diagnosis ratios. A mid-year audit corrects these patterns before they trigger an automated audit flag or demand letter in Q3 or Q4.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1782307532233\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\"><strong>Q5. What should we look for when evaluating an RCM services partner for mid-year support?<\/strong><\/strong>\r\n<p class=\"schema-faq-answer\">Look for specialty-specific coding expertise, MAC LCD familiarity for your geographic market, and a defined audit methodology \u2014 not just claim volume capacity. Ask for a sample mid-year AR aging analysis and denial root-cause report before engaging.<\/p>\r\n<\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"<p>A Mid-Year Billing Cleanup is a structured audit of your revenue cycle performed at the halfway point of the year to fix claim errors, reconcile unapplied payments, and stop revenue leakage before Q3 makes it worse. For physician groups and specialty practices, completing this review in June \u2014 not December \u2014 is what separates practices [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":30465,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,2],"tags":[6251,12,6250,6252,21,2833],"class_list":["post-30461","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-accounts-receivables","category-medical-billing-services","tag-billing-cleanup","tag-medical-billing-services-2","tag-mid-year-billing-cleanup","tag-q3","tag-revenue-cycle","tag-revenue-leakage"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Mid-Year Billing Cleanup: What Needs to Be Fixed Before Q3?<\/title>\n<meta name=\"description\" content=\"Learn how a Mid-Year 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