Billing guides that show their source
Guides on coding, denials, prior authorization and payer rules — each one written from the eCFR, the Federal Register and CMS’s own manuals, and each one naming the rule it relies on.
Newest first
-
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…
-
Peer-to-Peer Review Documentation That Wins More Appeals
By Danish William ·
Most peer-to-peer guidance treats the call as the event. It isn’t. The call is the last five minutes of a documentation process that started days…
-
NY Workers Comp 95-Day Filing: Electronic Billing Rules
By Danish William ·
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…
-
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…
-
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…
-
Medicare Advantage Prior Auth 72-Hour Deemed Approval Rule
By Danish William ·
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…
-
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…
-
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…
-
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…
-
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…