The briefing library
Every standalone issue, filterable by specialty. New briefings land as payer and CMS rules move.
Your second read is not being denied. It is being reduced.
A pre-submission radiology MPPR 2026 checklist covering the 50% technical and 5% professional reductions, modifier 26/TC splits, contrast…
Read →Why the same 97153 unit cap means two different things in two states
A 2026 state-by-state read on ABA 97153 authorization units and 97155 concurrency, showing why identical clinical hours get paid differently by plan,…
Read →Two clocks are running at once
The 97151-97158 adaptive behavior code set is slated for revision effective 2027, while states like Indiana add modifier gates and lifetime ABA…
Read →A claim can be paid in full and still be underpaid. Your 835 just calls it done.
A paid claim can still be underpaid. See how RecoveAR reconciles your X12 835 paid-vs-allowed lines against payer contract fee schedules, CMS 2026…
Read →What Landed on the 2026 ASC Covered Procedures List, and the 90-Day Clock That Starts the Day You Bill It
CMS added hundreds of procedures to the 2026 ASC Covered Procedures List. Here is the timeline from list addition through device-offset packaging to…
Read →CAQH and NCQA, side by side. Both cycles satisfied at once.
CAQH NCQA credentialing standards 2026, side by side: NCQA re-credentials every 36 months, CAQH re-attests every 120 days. See how Credential OS runs…
Read →The AT modifier is not a formality
A 2026 operator's read on the Medicare AT modifier for chiropractic CMT (98940-98942): the active-treatment vs maintenance-care line reviewers…
Read →Bill Collaborative Care everywhere. Chase it first where parity forces the check.
Pair the CMS CY2026 CoCM time-based codes (99492-99494, G2214, G0512) with a state-by-state parity map so behavioral health groups bill everywhere…
Read →The gap between a CPT and the right ICD specificity is where 2026 risk lives.
How ASP AI Engine walks an operative CPT descriptor to an anatomic region check to the HCC-relevant secondary diagnoses risk adjustment depends on, and…
Read →The Modifier Layer: how ASP AI Engine decides between 25, 59, and nothing at all
How ASP AI Engine handles AI modifier assignment for 25, 59 and the X{EPSU} subsets in 2026. See the evidence checklist it requires, mapped to the NCCI…
Read →An edit that fires is not a door that closes. It is a question the chart has to answer.
How ASP AI Engine, ASP-RCM's autonomous coding engine, reads a CCMI-1 NCCI PTP edit as conditionally bypassable with documentation instead of closed, and…
Read →Never miss the date that quietly stops your billing.
How Credential OS tracks every provider's PECOS revalidation due date and effective dates so a lapsed Medicare enrollment never silently turns a…
Read →Two conversion factors, both proposed to fall
CMS proposes CY 2027 conversion factors of $33.1693 (QPs) and $32.8409 (all others), down 1.19% and 1.68%, as the 2.5% statutory bump expires Dec 31,…
Read →How the 2.4% lands
CMS-1850-P, issued July 2, 2026, proposes a 2.4% OPPS and ASC payment update, continued Inpatient Only list phase-out, expanded site-neutral payment,…
Read →The scoreboard, in four numbers
60+ insurers pledged electronic prior authorization by January 1, 2027. What the AHIP commitments and the FHIR ePA standard mean for orthopedic,…
Read →Epidural and facet injections in 2026: count the level, don't pay twice for the picture
An interactive level-and-guidance calculator for epidural steroid injection billing in 2026, showing where fluoroscopy is already bundled and how…
Read →Eye Codes or E/M in 2026? The comparison most practices keep getting backward.
When eye codes (92002-92014) beat office E/M (99202-99215) in 2026, when E/M wins, and the 67028 injection-day bundling trap that erases your office…
Read →The cap moved $813. Your per-diem revenue moves faster.
CMS-1851-F, issued July 30, 2026, sets a 2.3% hospice payment update and a $36,174.75 aggregate cap effective October 1, 2026. What the FY 2027…
Read →How the FY 2027 IPPS final rule hospital payment update is built
CMS issued the FY 2027 IPPS/LTCH PPS Final Rule on August 4, 2026: a 2.3% hospital payment update effective October 1, 2026, about $2.1B in added…
Read →Recapture season has a clock, and it resets every January 1st.
The 2026 chronic-condition recapture checklist our CMS-HCC V28 engine runs on every chart, surfacing suspected-but-uncoded gaps without inventing a…
Read →V28 hits full weight in 2026. The blend that cushioned you is gone.
In 2026 the CMS-HCC V28 model lands at 100 percent weight. See, in one stat wall, where a group that coded fine under V24 now shows unexplained…
Read →From HIS to HOPE: the 2026 assessment change that quietly rewrites your billing rhythm
HOPE replaced HIS on October 1, 2025. See every HOPE timepoint mapped against the Medicare payment cycle, and exactly where a missed data window…
Read →The two smallest modifiers on the claim carry the largest reconciliation risk.
Your 2026 field guide to JW and JZ discarded-drug modifiers for oncology. Where single-dose vial wastage becomes CMS refund reconciliation exposure,…
Read →The map: one state is already live, 44 go live January 1, 2027
44 states must condition expansion-adult Medicaid eligibility on 80 hours per month of qualifying activity on January 1, 2027. What the eligibility…
Read →The procedure never decides the claim. The diagnosis and the benefit that covers it do.
Medical dental cross coding CDT 2026 made simple. A side-by-side matrix showing when the same procedure belongs on a CDT dental claim and when it…
Read →The road from lapse to runway
The Consolidated Appropriations Act, 2026, signed February 3, 2026, extends Medicare telehealth through December 31, 2027, keeping PT, OT and SLP on…
Read →Mohs in 2026: the single number that decides whether your claim survives audit
Mohs surgery billing in 2026 turns on one number: your stage count. See how CPT 17311-17315 stack, why the same-surgeon pathology rule voids claims,…
Read →The 2026 IDR compliance timeline
The Federal IDR Operations Final Rule cuts the administrative fee from $115 to $15 per party for disputes initiated on or after June 11, 2026,…
Read →The OB Global Package in 2026: Every Visit That Is Already Paid, and Every One That Is Not
A visit-by-visit map of the 2026 OB global package. See which encounters live inside 59400, 59510, and 59610, which unbundle legitimately, and how…
Read →Modifiers 24, 25, and 57 in the 2026 Global Period
A side-by-side comparison of modifiers 24, 25, and 57 in the 2026 global period, built for orthopedic practices losing post-op E/M revenue to blanket…
Read →The 2026 therapy threshold, in real dollars.
See when cumulative OT charges cross the 2026 KX modifier threshold and the $3,000 medical review line, so therapists append KX for the right reason,…
Read →The Part D redesign stops being policy and starts being your remittance in 2026.
The Part D redesign hits the pharmacy counter in 2026: the $2,100 out-of-pocket cap, Maximum Fair Prices on the first 10 negotiated drugs, and a…
Read →The same 30-day period does not pay the same across your service counties.
A CBSA wage-index geo-grid layered with LUPA-threshold risk, so home health agencies can see how the same 30-day PDGM period pays differently across…
Read →The 2026 pediatric vaccine update: getting administration codes and VFC right the first time
A pediatrics billing guide to 2026 vaccine administration coding: when counseling-based codes 90460 and 90461 apply, how to split VFC dual-billing…
Read →Primary Source Verification in 2026: The Expirables Credential OS Watches So You Do Not Have To
One expired license can claw back months of paid claims. Here is how continuous primary-source verification of the 2026 expirables turns…
Read →CMS relaxed the signature. It did not relax the plan of care.
A 2026 PT plan of care decision panel: which certification steps CMS relaxed in the CY2026 Physician Fee Schedule, which still gate payment, plus a…
Read →The new steady state, in four numbers
CMS now audits roughly 550 MA contracts every year on a quarterly RADV calendar, with PY 2020 audits starting as early as February 2026 and a…
Read →A RADV auditor never reads your intent. They read your chart.
A RADV auditor does not read your intent. They read your chart. Here is how the V28 risk-adjustment engine flags any submitted HCC that lacks MEAT…
Read →RecoveAR and the Denial Taxonomy: Turning 2026 CARC/RARC Codes Into a Ranked Worklist
See how RecoveAR parses the 835 remittance, classifies every CARC/RARC into a denial taxonomy, and routes soft denials to rework and hard denials to…
Read →The money in remote cardiac monitoring hides in three separate billable events. Most groups only catch two.
A component-by-component breakdown of remote cardiac monitoring reimbursement in 2026. See how device supply, transmission, and interpretation split…
Read →Your per diem is not one number. It is six, and one soft diagnosis moves most of them.
A component-by-component breakdown of the SNF PDPM 2026 per diem, showing how a soft primary-diagnosis mapping quietly drains the nursing and NTA…
Read →Speech and Audiology in 2026: A Layered Look at Thresholds, Direct Access, and Telehealth
A layered-card explainer for combined speech and audiology practices in 2026: how the SLP KX therapy threshold, the audiology AB direct-access rule,…
Read →Two clinicians, one encounter, and only one right way to bill it in 2026.
A side-by-side comparison of split/shared and incident-to billing conditions for 2026, built for multispecialty groups mixing physicians and APPs on…
Read →The telehealth cliff is a billing event, not a policy debate.
A date-by-date timeline of which Medicare telehealth allowances continue, which sunset, and the exact billing changes at each milestone, so your…
Read →Every payer runs a different clock. RecoveAR watches all of them at once.
See how RecoveAR tracks each commercial, Medicare, and Medicaid timely-filing clock in 2026 and surfaces recoverable claims before the deadline…
Read →One urgent-care visit. Two ways to bill it. That fork is where the money leaks.
Follow one urgent-care visit through the exact fork that drives most rework in 2026: the payer that wants the S9083 global case rate versus the payer…
Read →The cystoscopy is coded. The biopsy line is the one quietly deciding your margin.
How same-session cystoscopy and biopsy bundling quietly drains urology revenue under the CMS CY2026 Physician Fee Schedule, and where a distinct…
Read →One 270 inquiry in. One parsed 271 out. Zero phone-tree calls.
See how VoiceIQ turns one multi-specialty X12 270 inquiry into a parsed 271 with real benefit and accumulator data, retiring the phone-tree…
Read →The estimate is spoken, printed, and compliant before the patient leaves the desk.
How VoiceIQ turns live 271 accumulator data into a 2026-compliant Good Faith Estimate at the point of service, meeting No Surprises Act obligations…
Read →VoiceIQ and the 276/277 loop: a 2026 claim-status checklist
A 2026 operator checklist for automating claim-status follow-up with X12 276/277 and CAQH CORE, so your AR team acts on structured 277 responses…
Read →Plus: six monthly publications, by role
Role-specific monthly briefs for ABA chains, SUD and behavioral health programs, credentialing teams, medical groups on Medicare Advantage, hospital revenue cycle leaders, and hospital finance. Free to read; subscribe and we will email you the next issue.