20 new pieces. The October upgrade.

October brings the new emergency department billing page with a 184-rule, 50-state ER payer matrix, the October refresh of the ABA, behavioral health, therapy and FQHC payer matrices (98 new verified changes), the RCM terms and acronyms A to Z, and 20 new insights, guides, white papers and case studies. Every fact is linked to its primary source. No download form, no SDR follow-up.

5New case studies 5New white papers 5Newsletter issues 1Annual recap 38K+Words of new content

Published in October 2026.

White paper · ABAThe silent claim: an ABA operating guide to claim-status follow-upAn operating guide to ABA claims that never get answered: prompt-pay deadlines, a day 21, 35 and 45 status cadence, and remittance coverage tests.White paper · Emergency departmentDefending level 4 and 5 ER visits when payers review every oneAn operating guide for ER groups facing payer reviews of 99284 and 99285: policies by payer, Medicare dollars at stake, MDM proof and the appeal file.White paper · FQHCWho owes the PPS dollar: an FQHC operating guide to payment floors by payer classAn FQHC operating guide to the PPS floor by payer class: Medicaid MCO wraparound, Medicare Advantage supplemental payment, QHPs and commercial plans.White paper · Behavioral healthCCBHC billing in 2026: an operating guide to the four prospective payment optionsAn operating guide to CCBHC billing for the 10 states joining the Medicaid demonstration in 2026: the four PPS options, visit counting, MCO wraps and QBPs.White paper · Physical therapyMedicare outpatient therapy in 2027: the KX threshold operating guideOperating guide to Medicare outpatient therapy in 2027: proposed $2,540 KX threshold, $3,000 targeted review, accrual, MPPR, CQ/CO and RTM proposals.Insight · ABANew York Medicaid halves the technician rate for ABAFrom October 1, 2026 NY Medicaid FFS pays $9.63 per unit for technician ABA (97153), half the $19.26 BCBA rate. What changed and what to do now.Insight · Emergency departmentThe remit will now tell ER groups which claims can go to IDRNine No Surprises Act remark codes take effect Nov 1, 2026 and are required on remits from Jan 1, 2027. What ER groups must change in posting now.Insight · FQHCG2025 is gone for October dates of service: what FQHCs must bill insteadFrom October 1, 2026, FQHCs and RHCs stop billing Medicare distant site telehealth on G2025 and bill the actual CPT code with modifier 95 or 93.Insight · Behavioral healthThe DEA telemedicine cliff: what psychiatry and SUD practices must do before December 31, 2026The DEA special registration final rule went to White House review on Sept 21, 2026. What psychiatry and SUD practices should do before Dec 31.Insight · Physical therapyUnitedHealthcare cut 30% of prior auths on Oct. 1. Your PT auths are still on.UnitedHealthcare cut 30% of prior auth requirements on Oct. 1, 2026. Outpatient therapy comes later. What PT clinics should change now and what to keep.Case study · ABAA multi-state ABA group where the missing money was never deniedA multi-state ABA provider collected 85% of contract value. Our diagnostic found the gap was not denials: $5.05M of claims were never answered.Case study · Emergency departmentAn ER and hospitalist group's first four weeks: enrollment, not coding, was the leakA California emergency medicine and hospitalist group's first four weeks with us: 98.8% registered, 78.8% coded, and enrollment behind 45 of 46 denials.Case study · FQHCA multi-site FQHC network: what the first 70 days found in front of the payerA multi-site FQHC network: what the first 70 days of full revenue cycle work found in its encounter claims, front-end leak and credentialing queue.Case study · Behavioral healthWhat our first 60 days found at a behavioral health and SUD organization: $1.04M of AR waiting on credentialingWhat our first 60 days found at a Mid-Atlantic behavioral health and SUD organization: $1.04M of AR held for credentialing and 52.9% of AR over 90 days.Case study · Physical therapyWhat the first 30 days found in $6.39 million of PT accounts receivableWhat the first 30 days found in $6.39M of AR across 38 outpatient PT clinics: untouched aged claims, paid lines left open, and a filing-window queue.Guide · ABADo RBTs need an NPI? The payer-by-payer answerDo RBTs need an NPI? Federal law alone does not require one, but Optum, TRICARE and Indiana Medicaid now do. Here is the payer-by-payer answer for ABA.Guide · Emergency departmentHospitalist billing guidelines for 2026, admission to dischargeHospitalist billing guidelines for 2026: admit from the ED, observation, same-day discharge, daily visits, G0316 and the Medicare rule behind each code.Guide · FQHCFQHC sliding fee scale 2026: how to build it and bill it cleanlyHow to build an FQHC sliding fee scale for 2026: the HHS poverty guidelines, the 100% and 200% rules, discount bands, and billing it cleanly.Guide · Behavioral healthHow to get credentialed as a therapist: Medicare, Medicaid and commercial panels in 2026How to get credentialed as a therapist with Medicare, Medicaid and commercial panels in 2026: the federal clocks, the filing order and costly mistakes.Guide · Physical therapyThe physical therapy progress report Medicare expects, step by stepPhysical therapy progress report rules for Medicare: the 10-treatment-day rule, who writes it, 90-day recertification and the discharge note.

The August wave · newest 16 of 299

JUNE 2026 · CASE STUDIES

20 new pieces. The October upgrade.

Published in October 2026.

The August wave · newest 16 of 299

Five client engagements. Anonymized. With the math.

Three-way match reversed $1.4M of post-pay takebacks.

Wrap reconciliation surfaced $2.1M in interim limbo.

DNFB compressed 11d to 4d. $4.8M cash unlocked.

BCBA enrollment cut from 97 days to 22.

V28 RAF lift +0.14. $5.8M PMPY recovered.

The ABA Revenue Engine. Five papers, one system.

The Authorization Ledger: utilization is the master metric.

The Payer You Cannot See: eligibility and COB defense.

Unit Economics of the Session: clean claim engineering.

Fifty-Two Jurisdictions, One Claim: multi-state compliance.

The Escalation Ladder: denials as negotiation, not queue work.

Five open-access references. No email gate.

The CMS V28 playbook for risk-adjustment coding teams.

The three-way match handbook for ABA billing teams.

NCR over GCR: an honest collection framework for FQHCs.

The 80 denial patterns reference for RCM operations.

Cutting BCBA credentialing from 97 days to 22.

Three franchises. Five fresh issues.

Authorization gaps and the recapture playbook.

RAF attribution: where the lift actually comes from.

DRG drift: catching the silent capture loss.

Medicaid rate cuts, credentialing, parent A/R.

V28 condition map shifts and the recapture window.

What landed when. In order.

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