How to Run an Internal Medical Coding Audit: A Step-by-Step Guide
Most practices think about coding compliance reactively — after a payer audit letter arrives, or after a denial pattern gets […]
Regulatory & Compliance
Regulatory & Compliance
Regulatory & Compliance
HCC Coding and Risk Adjustment: A Beginner’s Guide
If you work in medical coding or revenue cycle management long enough, you’ll eventually run into a term that doesn’t […]
Regulatory & Compliance
ABN Forms Explained: When You Need One and How to Avoid Denials
An Advance Beneficiary Notice (ABN) is one of the few pieces of paperwork in Medicare billing that directly determines whether […]
Regulatory & Compliance
ICD-11 in the U.S.: Where the Transition Actually Stands in 2026
Search around and you’ll find plenty of 2024- and 2025-vintage articles confidently predicting an ICD-11 switchover in the U.S. “by […]
Regulatory & Compliance
CPT 2026 Code Changes: What Billers and Coders Need to Know
Every January 1st, a new CPT code set takes effect, and every January the same scramble happens: superbills reference deleted […]
Regulatory & Compliance
Prior Auth Gold Carding: Which States Have It and How It Works
“Gold carding” is the industry nickname for a fast-growing category of state laws that exempt individual providers from prior authorization […]
Regulatory & Compliance
CMS 2026 Physician Fee Schedule: What the New Conversion Factors Mean for Billers
Every fall, CMS finalizes the Medicare Physician Fee Schedule for the coming year, and every fall, “the conversion factor” briefly […]
Regulatory & Compliance
ICD-10-CM Coding Guide: Code Structure, Guidelines, and the FY2027 Update
How ICD-10-CM codes are structured, the specificity and laterality rules that cause the most denials, and what changes in the FY2027 update taking effect October 1, 2026.
Regulatory & Compliance
How to Qualify for CMS’s DME Prior Authorization Exemption Program
CMS exempts DME suppliers with a 90%+ affirmation rate from prior authorization. Learn the eligibility rules, evaluation cycle, and how exemptions get revoked.
Regulatory & Compliance
The Complete List of DME Codes Now Requiring Prior Authorization (Updated)
CMS’s Required Prior Authorization List grew to 74 DME HCPCS codes as of April 13, 2026. Here’s how the Master, F2F/WOPD, and PA lists relate and where to check them.