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Peer-to-Peer Review Documentation That Wins More Appeals
By Sarah Callahan ·
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…
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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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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 ·
Texas Medicaid providers write off tens of millions of dollars annually not because of clinical failures, but because of preventable claim rejections. The Texas Medicaid…
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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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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 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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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…
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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…