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TPE Audit Response: A Complete Step-by-Step Survival Guide
By Eman Zahra ·
The envelope looks routine. It isn’t. A Notice of Review from your Medicare Administrative Contractor means you’ve entered a Targeted Probe and Educate audit, and…
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CPT 99080 CMS-1500 Offset: Workers’ Comp E-Billing Rules
By Eman Zahra ·
CPT 99080 is a “by report” code originally meant for special reports. New York’s Workers’ Compensation Board repurposed it, capped at $1 per bill, to…
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QPA Benchmark 2026: Surprise Billing Rules for Physicians
By Eman Zahra ·
What Is the QPA in 2026 Physician Billing? The Qualifying Payment Amount is a health plan’s median contracted rate for a given service, frozen at…
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Collecting Patient Balances After Insurance Underpayment
By Eman Zahra ·
The distinction that destroys revenue cycles isn’t a billing error. It’s a misclassification — the silent moment when a payment poster treats an insurer’s $80…
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New Provider Not Credentialed? Why Claims Get Denied Now
By Eman Zahra ·
Picture the scenario. A new nurse practitioner starts Monday. Patients are booked through Friday. Front desk runs eligibility checks, sees an active plan, and the…
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NY Workers Comp 95-Day Filing: Electronic Billing Rules
By Eman Zahra ·
The 95-day rule doesn’t forgive ignorance. It doesn’t accommodate staffing gaps, software migrations, or a billing manager who missed the alert. New York’s Workers’ Compensation…
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Medicare Advantage Prior Auth 72-Hour Deemed Approval Rule
By Eman Zahra ·
CMS-0057-F is federal law. Starting January 1, 2026, Medicare Advantage organizations must send prior authorization decisions within 72 hours for expedited requests and seven calendar…
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Billing G0552 DMHT Devices: The 2025 Compliance Playbook
By Eman Zahra ·
CMS opened a new revenue channel for behavioral health practices on January 1, 2025. Three HCPCS codes—G0552, G0553, and G0554—now formally reimburse digital mental health…
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Offsetting 2026 Medicare Facility PE Cuts: A Billing Guide
By Eman Zahra ·
Congress passed a one-time 2.5 percent base pay bump for 2026. CMS quietly blunted it with a structural cut that most practices did not fully…
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ASM Heart Failure Billing: Mandatory Triggers Explained
By Eman Zahra ·
On October 31, 2025, CMS finalized the Ambulatory Specialty Model (ASM) inside the CY 2026 Medicare Physician Fee Schedule final rule. It targets general cardiologists…