Author: Sarah Callahan
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TPE Audit Response: A Complete Step-by-Step Survival Guide
By Sarah Callahan ·
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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What Happens After a RAC Audit Letter Hits Your Practice
By Sarah Callahan ·
The envelope looks routine until you open it. Inside sits a Recovery Audit Contractor letter, and your practice now has a clock running. What you…
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CMS-1832-F 2026: How Practice Expense Cuts Hit Cardiology
By Sarah Callahan ·
Cardiology just lost its facility-based payment cushion. CMS finalized CMS-1832-F on October 31, 2025, and the rule takes effect January 1, 2026. It rewrites how…
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QPA Benchmark 2026: Surprise Billing Rules for Physicians
By Sarah Callahan ·
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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Medicare Advantage 2026 Exits: Claims and Enrollment Gap
By Sarah Callahan ·
The numbers are not ambiguous. Approximately 2.9 million Medicare Advantage enrollees faced forced plan terminations in 2026. That is roughly 10% of all non-employer HMO…
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No Surprises Act 2026: Updated IDR Eligibility Checklist
By Sarah Callahan ·
As of January 31, 2026, disputing parties have filed over 5.1 million disputes through the federal IDR portal — fourteen times the annual volume CMS…
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Top Texas TMHP Claim Rejection Reasons and How to Fix It
By Sarah Callahan ·
This page is a reference for Texas Medicaid providers who have a claim back from the Texas Medicaid & Healthcare Partnership (TMHP) with a rejection…
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How to Build a FHIR ePA Workflow for Prior Auth in 2026
By Sarah Callahan ·
CMS-0057-F landed in the Federal Register on February 8, 2024, and its January 1, 2026 enforcement deadline has already divided healthcare revenue cycle operations into…
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Offsetting 2026 Medicare Facility PE Cuts: A Billing Guide
By Sarah Callahan ·
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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Medicare 2026 Virtual Direct Supervision: The Audit Shield
By Sarah Callahan ·
The CY 2026 Medicare Physician Fee Schedule Final Rule became permanent on January 1, 2026, and most billing departments celebrated. Medicare Administrative Contractors did not…