Every insight, one desk
Filter by lane. Each analysis says what changed, who it hits, and the number that matters.
92014 or 99214? The eye-exam code choice that pays differently every time.
Eye codes 92002-92014 or E/M 99202-99215 in 2026? Use our optometry and ophthalmology coding calculator to pick the higher-value, audit-defensible…
Read →The 97153 Unit Cap Map: why ABA reimbursement changes at the state line
How 2026 state Medicaid unit caps and concurrent 97155/97153 rules for ABA code 97153 diverge, the EPSDT floor beneath them, and what multi-state ABA…
Read →The answer first: the pledge is real, the relief mostly is not, yet
One year after the June 23, 2025 industry pledge, AHIP reports an 11% prior auth volume reduction and 6.5 million requirements eliminated, yet only…
Read →What changed, and when
AHCCCS is rewriting AMPM 320S while ACC and RBHA reprocurement reshuffles plan assignments. What the June 19, 2026 revision memo, the April 3, 2026…
Read →The case is on the list. Does the facility fee actually cover the implant?
A scheduler-first read of the CY2026 OPPS/ASC final rule and CMS ASC Covered Procedures List. See which cases clear a facility fee, and how…
Read →Two provider types, one rulebook, and a stack of billing layers
A layered-card guide to what audiology can bill under 2026 direct access, what still needs a physician order, and how SLP telehealth and AAC device…
Read →Half the comment window is already gone
CMS-1848-P, the CY 2027 Medicare PFS proposed rule, keeps building behavioral health integration payment pathways into chronic care management.…
Read →Behavioral health telehealth after 2025. The dated timeline your intake team can actually rely on.
A dated timeline of which behavioral and mental health telehealth and audio-only Medicare allowances became permanent versus extended for 2026, with…
Read →A dated timeline of what DWC actually did this year
California's DWC adopted Medicare RVU26B and RVU26C into the OMFS within months of each other. Why annual fee schedule loads now misprice workers…
Read →Yes, you can bill cardiac RPM and CCM in the same month. Just never the same minute.
A 2026 operator's guide to billing Remote Physiologic Monitoring and Chronic Care Management together on a cardiology panel, with an interactive…
Read →Two years, four dates, one new enforcement reality
As of February 16, 2026 OCR accepts 42 CFR Part 2 complaints and can pursue HIPAA-style civil penalties for SUD confidentiality violations. What the…
Read →The AT modifier checklist that keeps Medicare from calling it maintenance care
A pre-claim checklist for chiropractic billing that separates active-treatment CMT from non-covered maintenance so 98940, 98941, and 98942 survive…
Read →Flow 01How an R49 downcode actually happens
Cigna Reimbursement Policy R49, effective Oct. 1, 2025, auto-downcodes 99204-99205, 99214-99215 and 99244-99245 by one level for profiled providers.…
Read →Who is on the clock
CMS-0057-F is live: 72-hour expedited and 7-calendar-day standard prior auth decisions since Jan. 1, 2026, public PA metrics posted March 31, 2026,…
Read →The rulemaking clock is already running
CMS-1848-P would end Medicare payment for vendor-furnished RPM and RTM management services on January 1, 2027 and require a face-to-face initiating…
Read →How Colorado got here
Colorado's FY2026-27 budget sets the adult dental cap at $3,000 while cutting every Medicaid rate 2% effective July 1, 2026. What dental practices…
Read →The write-off that hides in December.
Commercial ABA plans carry annual and lifetime benefit caps that quietly deny late-year sessions. Learn how benefit-accumulator and…
Read →Leveling E/M by MDM in 2026: what the engine weighs that a coder rushes
See how CorePulse scores the 2026 AMA MDM grid to justify each office E/M level, and exactly where the G2211 complexity add-on legitimately attaches.…
Read →The FY2026 ICD-10 code calendar an AI coding engine must honor
FY2026 ICD-10-CM took effect Oct 1 2025 and a mid-year update lands Apr 1 2026. See the full code calendar and how CorePulse switches code books by…
Read →The NCCI edits humans skip
Most over-coding is not a missing rule. It is unenforced NCCI. See where CorePulse catches PTP and MUE edits at claim build, how it reads CCMI…
Read →Continuous vs Three-Year: The Cycle NCQA Now Rewards
NCQA still caps recredentialing at 36 months, but continuous monitoring is now what keeps the file clean between cycles. Here is how Credential OS…
Read →A credentialed provider who is not enrolled cannot bill a dime.
Every day a provider sits un-enrolled is a day of care you cannot bill. Here is the credentialing-to-cash timeline, the real NCQA, CMS, CAQH and…
Read →Five rulemaking cycles on one dated timeline
CMS-1844-P, issued July 2026, proposes no new permanent PDGM behavioral adjustment for the first time in five cycles, a net +2.4% (about $420M)…
Read →The two numbers your CY2027 budget hangs on
CMS-1848-P proposes a CY2027 Medicare Physician Fee Schedule conversion factor of $32.8409 for non-QPs (-1.68%) and $33.1693 for QPs (-1.19%) as the…
Read →The rule in five numbers
CMS-1850-P proposes a 2.4% CY2027 payment update for OPPS and ASC while cutting 340B-acquired drugs to ASP minus 33.4%. Comments close August 31,…
Read →A dental code earns a spot on a medical claim the moment the tooth work is treating a medical problem.
A layered, visual guide to dental-medical cross coding in 2026: how a CDT 2026 code peels down to the ICD-10-CM diagnosis and CPT/HCPCS code that…
Read →The Modifier 25 number every dermatology practice should watch in 2026
The Modifier 25 metric every dermatology practice should track in 2026, plus the CPT 2026 E/M and biopsy code rules and documentation that make a…
Read →The 2026 delegation matrix, built only from the payers' own documents
Payers moved prior auth service lines between eviCore, Carelon, and in-house review four times between Jan. and Apr. 2026. Build a per-payer UM…
Read →Three dates that define the new landscape
Florida moved under-21 behavior analysis into nine MMA plans on Feb 1, 2025, then bound them to Rule 59G-4.125 with a new CDE requirement. Here is…
Read →Where the resets are landing
South Carolina finalized FQHC payment methodology amendments effective April 1, 2026, North Carolina's revised methodology is already live, and the…
Read →Proposed vs. final: the cap came in lower
CMS finalized the FY 2027 hospice aggregate cap at $36,174.75 with a 2.3% payment update worth about $755 million. What CMS-1851-F changes, why HOPE…
Read →The FY2027 Rate Dial
CMS-1845-F, issued July 30, 2026, finalizes a 2.3% FY2027 IRF payment update (3.2% market basket less 0.9 productivity), refreshed CMG weights,…
Read →One headline rate, three numbers your CFO actually cares about
CMS finalized a 2.3% FY2027 IPPS payment update worth approximately $2.1 billion, effective October 1, 2026 (CMS-1849-F). What hospital finance teams…
Read →The FY2027 dial: where 2.4 percent comes from
CMS-1843-F finalizes a 2.4% FY 2027 SNF PPS final rule update worth $882.74M, effective October 1, 2026, plus a path to all-payer MDS submission…
Read →One add-on. Twelve different right answers.
How the CY2026 MPFS G2211 visit-complexity add-on applies across twelve specialties in one multispecialty group, and where same-day modifier 25…
Read →Why this report matters more than the usual oversight letter
GAO-25-107342 found CMS audited zero behavioral health prior authorization requests in Medicare Advantage. Here is what the recommendation requires,…
Read →Route every post-op touchpoint to the right global-period modifier
A CY2026 process flow that routes every orthopedic post-op touchpoint to the correct global-period modifier (24, 25, 57, 58, 78, 79) so bundled…
Read →The coverage wall: 22 of 50
Ground ambulance sits outside the federal No Surprises Act. New Hampshire's ban took effect Jan. 1, 2026, bringing the state count to 22. What…
Read →Coding to Survive RADV: the MEAT behind every 2026 HCC
A side-by-side matrix pairing common HCC-driving diagnoses with the exact MEAT evidence an extrapolated 2026 RADV audit will demand, mapped to the…
Read →The chronic conditions your engine should flag before the reset closes
A calculator view of unrecaptured chronic HCCs under CMS-HCC V28 and the exact documentation each needs before the annual risk-adjustment reset…
Read →From HIS to HOPE: the assessment timeline that now drives your billing
The HOPE assessment replaced HIS on October 1, 2025. See every HOPE timepoint on one vertical timeline and exactly how a missed visit ripples into…
Read →The money hiding in your last seven days of care
How a 25-census community hospice protects its aggregate cap position and captures Service Intensity Add-on revenue on RN and MSW visits in the last…
Read →The enforcement wave in numbers
CMS issued 519 hospital price transparency noncompliance letters in ten weeks after April 1, 2026. What the CMS-1834-F enforcement wave means, and…
Read →The number that matters: 4,000 hours
Indiana FSSA bulletin BT202627 cut ABA rates 6% on April 1, 2026, added diagnosis-based weekly hour caps, a 4,000-hour lifetime limit, EPSDT-only…
Read →The dated timeline every revenue cycle leader should pin up
CMS-1850-P proposes removing 637 services from the Inpatient Only list for CY 2027 and adding 618 to the ASC Covered Procedures List, on the road to…
Read →JW vs JZ in 2026: the wastage call auditors now expect on every single-dose vial
A single-dose vial billing matrix that separates the scenarios demanding JZ from the ones requiring JW, plus the exact documentation each needs to…
Read →How we got here
Maryland fined Cigna $80,000 on March 13, 2026 and ordered a stop to automatic E/M downcoding under Policy R49. Why the first state enforcement…
Read →What actually happened, and when
EOHHS proposes re-adopting 101 CMR 358.00 with zero rate change, holding MassHealth ABA reimbursement rates at October 2024 levels into 2027. What…
Read →Aged AR is not one pile. It is four different clocks, and some of the oldest dollars are still alive.
Under Medicaid, aged behavioral health AR is not all worth the same. Learn why out-of-network claims survive longer, why the wrong-delivery-system…
Read →What changedThree windows, one law, one date
H.R.1 (P.L. 119-21) cuts Medicaid retroactive eligibility to one month for expansion adults and two months for other enrollees on Jan. 1, 2027. What…
Read →One rule, two caps: the SDP exposure map
CMS-2449-P caps new Medicaid state directed payments at 110% of Medicare in non-expansion states and 100% in expansion states, ramps grandfathered…
Read →How the mandate flows from statute to your front desk
CMS SMD #26-001 requires six-month eligibility redeterminations for Medicaid expansion adults starting Jan. 1, 2027. What twice-yearly churn means…
Read →The numbers that set the stakes
CMS-2454-IFC makes Medicaid work requirements regulation: an 80-hour monthly standard for expansion adults 19-64, state compliance due January 1,…
Read →The 2027 exit wave in four numbers
Humana announced additional 2027 Medicare Advantage market exits in July 2026, its second straight retrenchment year. Presbyterian (NM) and…
Read →Why 2.48% forces a benefit redesign
CMS set the CY2027 MA payment update at 2.48%. Why carriers are cutting grocery cards, OTC allowances and $0 premiums, and what it means for provider…
Read →The Medicare Effective-Date Trap:a PECOS enrollment checklist
A field-tested PECOS and CMS-855 enrollment checklist built around the Medicare effective date and the 30-day retrospective billing window, so no…
Read →The dated timeline: how the cliff moved
CAA 2026 extends Medicare telehealth flexibilities, including audio-only, through December 31, 2027, and CMS-1848-P proposes delaying the in-person…
Read →Today vs. January 1, 2027: the comparison matrix
CMS-1848-P proposes five additions to the Medicare Telehealth List and two new modifiers, BB and BC, required from January 1, 2027. What coding and…
Read →How Policy 8F Went From Draft to De Facto Enforcement in 82 Days
North Carolina's draft Clinical Coverage Policy 8F rewrites Medicaid autism treatment as RB-BHT. See the dated timeline, the paraprofessional…
Read →The October 1, 2026 NCCI files post in September. If your scrubber still runs January rules, it is already two versions stale.
The October 1, 2026 NCCI PTP and MUE files post in September. Here is the 30-day pre-quarter review that keeps scrubber rules current and clean…
Read →What changed, and when
Nebraska implemented H.R.1 Medicaid community engagement requirements on May 1, 2026, first in the nation. What the live test case means for churn,…
Read →What actually changed, in one read
New York extended commercial telehealth payment parity through April 1, 2028 under PHL Article 29-G Section 2999-dd, while its Medicaid Update…
Read →The answer first: Federal IDR crossed 5.1 million cumulative disputes as of January 31, 2026, and the 2026 IDR Operations Final Rule cuts dispute fees by more than 85% while moving all filings to a centralized IDR Gateway in the second half of 2026.
Federal IDR passed 5.1 million disputes as of January 31, 2026. The IDR Operations Final Rule cuts fees more than 85% and moves filings to a new IDR…
Read →What OIG is actually reviewing
OIG Work Plan item SRS-E-26-004 puts Medicare Advantage prior authorization for post-acute care under review. What hospitals and SNFs should start…
Read →The needle has moved into the red zone
OIG's open Work Plan audit of Medicare Part B remote patient monitoring is ongoing in FY2026. The four things OIG tests, and how RPM billers should…
Read →The 2026 win is a first-pass clean claim, not a bigger fee schedule.
How comprehensive ophthalmology and retina practices protect revenue in 2026: eye codes 92002-92014 vs E/M selection, LCD cataract and blepharoplasty…
Read →What changed, and when
Since Jan. 1, 2026, every Optum Behavioral Health commercial claim must carry NPI plus taxonomy for both billing and rendering providers or it…
Read →When your OTA touches the visit, the payment math changes. Here is the checklist.
A visual, operator-built checklist that flags exactly when OTA-furnished occupational therapy triggers the CO modifier under the CY2026 MPFS, and…
Read →Facet, Medial Branch, and Fluoroscopy: What 2026 Bundles and What It Does Not
A 2026 billing explainer for paravertebral facet and medial branch injections: where fluoroscopic and CT guidance is baked in and not separately…
Read →PDGM 2026 by Region: Where the Wage Index and LUPA Math Turns Against You
A geo-grid of how the CY2026 Home Health PPS final rule reshapes 30-day episode margins by region, where the CBSA wage index drops toward the 5% cap…
Read →Your whole Part A rate hangs on one field on the MDS.
A visual walkthrough of how a SNF admission diagnosis routes through PDPM clinical-category mapping in 2026, and exactly where a single miscode…
Read →2026 Pediatric Vaccine Coding: Pair Every Product Code With the Right Counseling Admin and VFC Stock
A 2026 pediatric vaccine billing checklist that pairs each CPT 2026 vaccine product code with the correct counseling administration code (90460/90461…
Read →One drug. Two benefits. The split decides the margin.
How a single provider-administered drug lands on the medical or pharmacy benefit, why the split decides margin, and what NADAC, 340B, ASP and JW/JZ…
Read →RTM is a recurring monthly line. Most PT clinics still bill zero of it.
Remote Therapeutic Monitoring is a recurring monthly line most PT clinics still bill zero of. Here are the CY2026 MPFS codes (98975-98978,…
Read →The 12-month postpartum extension quietly reopened 10 months of billable visits.
A 2026 state map of extended postpartum Medicaid coverage and the OB visits you can bill outside the global obstetric package once the 12-month…
Read →The PC/TC split is tighter in 2026. AUC just went quiet.
A CY2026 radiology billing brief on getting the professional (26) and technical (TC) component split right, modeling the Multiple Procedure Payment…
Read →The scale shift, in four numbers
CMS is auditing all RADV-eligible Medicare Advantage contracts annually, roughly 550 plans instead of about 60, with about 2,000 certified coders,…
Read →A denial code is not a verdict. It is a routing instruction you have not read yet.
RecoveAR CARC RARC denial mapping for 2026: a side-by-side matrix that turns X12 835 CARC and RARC combinations into the exact root-cause work queue…
Read →The 2027 prior-auth API deadline is really a 2026 AR problem.
The CMS-0057-F Prior Authorization API goes live January 1, 2027, but the 72-hour and 7-day decision clocks are already running in 2026. Here is how…
Read →One flat code pays the same for a sore throat and a laceration repair.
When the S9083 global urgent care case rate helps your revenue and when it quietly caps it against fee-for-service. Operator-level guidance on S9083…
Read →The grandfather clause just got narrower
CMS-1850-P would pay excepted off-campus HOPDs 40% of the OPPS rate for imaging without contrast in CY 2027, a roughly 60% cut. Comments close August…
Read →Two clinicians, one patient, one claim. Who bills it?
When a physician and an NPP both touch a facility patient, who bills the visit in 2026? A decision flow built on the CY2026 MPFS substantive-portion…
Read →The map: where the playbook has landed
Four Medicaid agencies moved on ABA cost containment in eight months. How Indiana FSSA BT202627's three levers, accreditation gates, hour caps, and…
Read →The map that changes: CJR goes from selected markets to the whole country
The FY 2027 IPPS final rule (CMS-1849-F) expands TEAM spinal fusion episodes and makes CJR mandatory nationwide from January 1, 2028. What hospital…
Read →Why the two numbers diverge
Texas raised its workers' comp conversion factor 2.7% for 2026 under the 28 TAC Medical Fee Guideline MEI methodology while Medicare's 2026 PFS…
Read →The claim that pays is the one filed before its window shuts.
RecoveAR ranks open denials by deadline proximity, not balance size, so accounts nearing timely-filing and appeal windows get worked first. See where…
Read →The 2026 edit matrix, side by side
UnitedHealthcare reimbursement policy update 2026: a 60% payment reduction on G0463 with modifier PO from March 1, 2026, and a qualifying ICD-10 gate…
Read →Which urology pairings bundle, and which unbundle with a distinct service
A 2026 side-by-side matrix of common urology same-session pairings showing which cystoscopy and urodynamics codes bundle into one line and which…
Read →V28, Fully Phased In: What the Final Blend Year Does to 2026 Risk Scores
CY2026 is the first year CMS-HCC risk scores run on 100% V28. See the phase-in timeline and the exact HCC categories whose remap or removal cuts 2026…
Read →Every VoiceIQ call clears three legal layers before it ever asks for a dollar.
Before a VoiceIQ AI voice agent asks a patient for a dollar, the call passes through three legal layers: TCPA consent, FDCPA Regulation F timing and…
Read →The estimate every uninsured patient is owed, said out loud at scheduling.
How VoiceIQ delivers a compliant No Surprises Act Good Faith Estimate to uninsured and self-pay patients at the point of scheduling, and how it fits…
Read →When the 277 comes back thin, VoiceIQ picks up the phone.
When a payer's 276/277 claim-status response is thin or unsupported, VoiceIQ falls back to AI voice to work the status call. See the fallback flow,…
Read →Arizona showed us what MCO termination looks like.
Between October 2025 and March 2026, three Arizona MCOs terminated contracts with Centria Autism and Action Behavior Centers. Nearly 1,000 children…
Read →The Dr. Oz Medicaid revalidation directive is now a CFO line item.
CMS Administrator Dr. Oz directed all 50 governors to file a 2-year provider revalidation strategy in 30 days. ABA was named as high-risk. Here is…
Read →Indiana Bulletin BT202627: the most restrictive ABA Medicaid policy in the country.
Indiana's April 1, 2026 ABA bulletin combines a 6% rate cut, 30-hour weekly cap, 4,000-hour lifetime cap, and an October 1 age-21 cliff. Here is what…
Read →North Carolina rewrote ABA Medicaid in one bill.
HB 696 banned telehealth-only ABA, locked out-of-state BCBAs out of NC Medicaid, and triggered the Policy 8F redraft. What every ABA chain operating…
Read →Optum BH commercial ABA claims need NPI and taxonomy validation starting January 1, 2026.
Optum BH (UHC commercial) begins enforcing NPI and taxonomy validation on ABA claims January 1, 2026. Soft-launch edits started Q4 2025. Here is what…
Read →Sunshine Health paused new practitioner enrollment in existing Florida ABA groups.
Florida Centene subsidiary Sunshine Health stopped accepting new practitioner additions into existing ABA provider groups in October 2025. Here is…
Read →TRICARE 2026 cost shares and copays changed. ABA practices need to update collection workflows.
TRICARE 2026 benefit year brings updated cost shares, copays, and enrollment fees across TRICARE Prime, Select, and the ABA-relevant ACD…
Read →The DOJ probe puts the in-home HRA playbook on trial.
UnitedHealth's Q1 2026 SEC filing acknowledged a DOJ criminal investigation. Senator Grassley's 50,000-page majority staff report dissects the…
Read →OIG's first major MA Compliance Program Guidance since 1999.
In February 2026, HHS-OIG published the Industry-Specific Compliance Program Guidance for Medicare Advantage. It names by name the operational…
Read →CMS paid plans $13B more in CY 2027. And killed retrospective sweeps.
The CY 2027 MA Rate Notice came in at +2.48% / +$13B, far above the January advance notice. But CMS finalized the exclusion of unlinked chart-review…
Read →CJR-X: first mandatory nationwide bundle lands October 2027.
Inside the FY27 IPPS proposed rule, CMS proposed CJR-X. Mandatory. Nationwide. Lower extremity joint replacement. 90-day episode covering all Part A…
Read →FY27 IPPS proposed rule: 2.4% bump and a $564M DSH cut.
CMS released the FY27 IPPS proposed rule on April 10, 2026. Headline 2.4% rate update with a $564M cut to DSH and UCP, even as the agency projects…
Read →Price transparency enforcement is now real money.
CMS enforcement of the updated Hospital Price Transparency requirements went live April 1, 2026. New machine-readable file requirements, CMPs $3K to…
Read →Choose the operating model, not the best-looking proposal.
Evaluate a physical therapy billing company with a weighted scorecard covering PT controls, pricing, transition, security, governance and proof.
Read →Stop PT denials before they become appeal inventory.
A PT billing playbook for preventing denials through benefit, visit-limit, prior authorization, plan-of-care, documentation and payer controls.
Read →Put KX, GP and CQ behind evidence gates.
A 2026 physical therapy billing guide to KX, GP and CQ modifiers, including the $2,480 KX threshold, PTA de minimis controls and claim examples.
Read →The Medicare 8-minute rule, turned into a claim-ready control.
A practical 2026 Medicare 8-minute rule guide for physical therapy billing, with timed-unit ranges, examples, allocation controls and documentation…
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