Explore insights, tips, and updates from the world of medical billing.
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Florida Medicaid does not pay hospice from one flat rate sheet. Here is how the revenue codes, level-of-care payments, SIA add-ons, and AHCA provider-specific rate letters work in 2026, and how to validate what is owed to your agency
Every unpaid claim gets tougher to collect with each passing week. Here is a practical year-end plan to sort aging A/R, fix root causes, work denials, and collect patient balances before the wind up for 2026.
Transitional care management can add meaningful revenue after every hospital discharge, but only when billing is leakproof. Here is how NY Medicaid TCM codes 99495 and 99496, fee schedule lookups, and filing limits work in 2026.
You miss the filing window with Aetna, and the claim comes back with a CO-29 denial which is rarely recoverable. Here are all the Aetna deadlines your billing team needs for 2026.
99214 is the most billed E/M code in Medicare and the one auditors review. Here's how to code it correctly, document it to withstand an audit, and avoid the revenue loss of underbilling it.
Billing for home health services relies on accuracy: an incorrect answer on the OASIS form or a missed deadline can affect the payment for a full 30-day cycle. The following explains how the process works under the 2026 regulations.
CCM turns the care your team already coordinates between visits into recurring, billable Medicare revenue. Below is an explanation of how the program works and what it can contribute to your financial results.
Internal medicine cares for some of the most clinically complex patients in primary care. Selecting MIPS measures that reflect that complexity rather than working against it is the key to achieving a good score.
Family medicine has 62 eligible MIPS measures to choose from; most practices only need six. Here is how to select the ones that will truly protect your score.
The NCQA’s most recent update to the PCMH model focuses almost exclusively on care management—specifically, how patients are identified, enrolled, and documented. The changes and projected timelines are detailed below.
The 2026 MIPS performance year rewards accuracy, not assumptions. Below are the reporting errors that are quietly costing practices points, along with how to correct them before submission.
A practical breakdown of how MIPS scoring categories work for 2026 and the specific actions eligible clinicians can take during this performance year to raise their final score well above 90 points.
Achieving a positive MIPS adjustment is not simply a matter of clearing a low threshold; it requires performing above the national average. Here is how small practices can position their 2026 score to achieve exactly that.
Discover practical strategies to avoid negative MIPS payment adjustments in 2026 by improving performance in the Quality, Cost, Promoting Interoperability, and Improvement Activities categories, with expert guidance from ESOFTX, Inc.
PCMH recognition may seem designed for large health systems, but small practices achieve it every day. Below is a realistic, step-by-step path based on current NCQA standards.
Discover how professional medical billing services in New York help healthcare providers increase revenue, reduce claim denials, improve cash flow, and optimize revenue cycle management with ESOFTX, Inc.
