Home Health Billing: Why OASIS Documentation Determines Your Payment
Home health billing runs on PDGM, and OASIS assessment accuracy drives payment for the entire 30-day period. Here’s where documentation commonly breaks down.
Specialty Billing
Credentialing & Enrollment
TIN/NPI Mismatches: The Silent Killer of Clean Enrollment
A provider can be fully credentialed and still see claims deny for months because the TIN and NPI on file don’t match what the payer expects. Here’s where mismatches come from and how to catch them.
Specialty Billing
Telehealth Billing in 2026: What’s Actually Reimbursable Right Now
Medicare telehealth flexibilities are extended through December 2027 under the Consolidated Appropriations Act of 2026. Here’s what’s covered, what’s uncertain, and what billing teams should track.
Denial Management & RCM
Coordination of Benefits Errors: Why They’re More Common Than You Think
COB denials often get lumped into a generic ‘eligibility’ bucket, so practices rarely see how much denial volume this actually represents. Here’s how to catch it and fix it.
Regulatory & Compliance
The 5 APIs Payers Must Support Under CMS’s Prior Auth Rule (And What It Means for Billers)
CMS-0057-F requires payers to build five FHIR APIs by January 2027. Here’s what each one does and how it changes prior authorization workflow for billers.
Regulatory & Compliance
What CMS’s Electronic Prior Authorization Rule Means for Your Practice Before the January 2027 Deadline
CMS-0057-F’s electronic prior auth API deadline hits January 1, 2027. Learn what’s already required now, what changes then, and how to prepare your practice.
Credentialing & Enrollment
Recredentialing: What Triggers It and How to Stay Ahead of the Deadline
Recredentialing lapses are one of the most preventable causes of billing disruption. Here’s what actually triggers a recredentialing review and how to build a calendar that catches it early.
Specialty Billing
Dermatology Billing: Cosmetic vs. Medically Necessary and How to Document the Difference
Dermatology billing sits on a spectrum between cosmetic and medically necessary. Here’s how documentation actually distinguishes the two, and where practices get caught out.
Regulatory & Compliance
5 Regulatory Deadlines RCM Teams Should Have on Their Calendar Right Now
IDR batching, CARC/RARC guidance, CMS-0057-F APIs, DMEPOS list updates, and the exemption cycle. Five concrete regulatory dates every RCM team should have on one shared calendar right now.
Credentialing & Enrollment
Why New Providers Sit Unbillable for Months (and How to Fix the Timeline)
A new provider seeing patients on day one doesn’t mean revenue on day one. Here’s why credentialing lag creates months of unbillable claims, and how to close the gap.