Long-form field guides from the desk.

ABA billing for multiple locations: one model for every site

One payer matrix, one auth ledger, one denial queue. How multi-location ABA groups centralize billing and carry every state rule into 2027.

ABA Medicaid rate cuts 2027: the margin playbook

Indiana, New York and Nebraska reset ABA Medicaid rates into 2027. Unit capture, clean claims and payer mix: the levers that hold margin.

Automated eligibility verification systems: the 2027 buyer's guide

Eight criteria and a weighted scorecard: 270/271 depth, thin-271 handling, fallback order, CMS-0057-F API data, benefit maxima, network truth, exceptions.

Credentialing revalidation 2027: one operating model for every cycle

Medicare revalidation, CAQH, payer recreds, licenses and the CY2027 retroactive-revocation proposal, run as one calendar with one owner per date in CredPro.

ED facility E/M leveling defense: EDC Analyzer and Anthem G-19002

How UHC's EDC Analyzer and Anthem G-19002 re-level facility 99284 and 99285 claims, the exclusions, pre-bill checks and the appeal file that holds in 2027.

NSA IDR Gateway 2027: an operating manual for ER groups

Gateway filing from Nov 13, 2026, web forms closed after Jan 15, 2027, 50-line batches from Nov 1 and the $15 fee: roles, queues and clocks for ER groups.

FQHC APM vs PPS: the Medicaid decision guide

When an APM beats PPS, how the at-least-PPS floor is tested, what reconciliation looks like under each path, and the 2026 SPAs with sources.

FQHC revenue cycle management: the 12-KPI scorecard

Twelve measures built for PPS: NCR versus PPS by payer class, wrap recovery and aging, Medicare add-on capture, sliding-fee leakage and front-end inventories.

HCC 2027: unlinked chart reviews lose their weight

CMS excludes unlinked chart review diagnoses from PY2027 risk scores, built on 2026 visits. The exposure math and nine moves to capture at the encounter.

RADV audit response playbook 2027

PY2022 audits start January 2027, PY2025 in April. Four phases from the CMS PY2024 instructions: intake, retrieval, checklist validation, discrepancies.

340B rebate model 2027: hospital cash playbook

HRSA's rebate pilot turns the 340B discount on selected drugs into a 45-day, 10-day receivable from January 1, 2027. A pharmacy-to-finance playbook.

Hospital price transparency MRF audit checklist 2027

A seven-block self-audit of the machine-readable file after the 2026 changes: access, charges, allowed-amount fields, attestation, display, penalties, the 2027

Mental health billing services: 2027 buyer's guide

Parity pause, telehealth in-person rule and the prior authorization API, turned into vendor questions, nine contractable KPIs and a 60-day selection plan.

MHPAEA parity claims: provider playbook 2026

Federal parity enforcement is paused; the statute and your 835s are not. Four exhibits, two arguments in order, and the regulator route for every plan type.

Occupational therapy billing guide 2027

Evaluation levels 97165 to 97168, the 8-minute unit table, GO, CO and KX, the OT threshold proposed at $2,540, RTM conditions and RAC topic 0228.

Physical therapy billing services: 2027 scorecard

Ten criteria with weights and the evidence to request, each tied to a January 2027 rule: units, KX, plan-of-care clocks, RTM, denials, telehealth, reporting.

CPT 2027 maternity codes: transition playbook for OB groups

17 maternity codes deleted, 12 added, antepartum and postpartum care to E/M from January 1, 2027: the code map, the December 31 rules and the January audit.

Urgent care after-hours codes 99050, 99051 and 99058: the POS 20 rulebook

Medicare bundles every after-hours code, UHC pays two only outside POS 20, Cigna pays two with a condition. The payer table, claim build and contract clause.

Urgent care billing services: the 2027 operating manual

Twelve controls for urgent care billing: POS 20, S9083 by payer, the CY2027 same-day E/M proposal, telehealth modifiers, front-desk cash, nine KPIs.

The denial management worklist: CARC to root cause, owner and deadline

How Work Genie reads the 835, maps every CARC and RARC pair to a root cause, owner and deadline, and what the October 1, 2026 code update changed.

The silent claim: an ABA operating guide to claim-status follow-up

An operating guide to ABA claims that never get answered: prompt-pay deadlines, a day 21, 35 and 45 status cadence, and remittance coverage tests.

Defending level 4 and 5 ER visits when payers review every one

An 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.

Who owes the PPS dollar: an FQHC operating guide to payment floors by payer class

An FQHC operating guide to the PPS floor by payer class: Medicaid MCO wraparound, Medicare Advantage supplemental payment, QHPs and commercial plans.

CCBHC billing in 2026: an operating guide to the four prospective payment options

An 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.

Medicare outpatient therapy in 2027: the KX threshold operating guide

Operating guide to Medicare outpatient therapy in 2027: proposed $2,540 KX threshold, $3,000 targeted review, accrual, MPPR, CQ/CO and RTM proposals.

The 2027 ABA Compliance Countdown: certification, licensure, accreditation, and the new CPT codes.

There is no national BCBA-or-RBT-only mandate for January 2027. There are eight real deadlines between August 2026 and December 2027. The full calendar, the Illinois ownership decision tree, and the 90-day operating plan.

The 835 Reconciliation Handbook: post the remit line by line, then tie out to the penny.

835 anatomy, line-level 837 matching, the three-point deposit to remit to posting tie-out, PLB handling, and the exception buckets where recoverable dollars hide.

The PDPM Revenue Integrity Guide: five components, one MDS, and the days your rate quietly decays.

PT, OT, SLP, nursing, and NTA case mix, variable per diem decay, MDS accuracy as revenue integrity, consolidated billing boundaries, and where Medicare Advantage diverges from FFS.

Outpatient Therapy Revenue Integrity: the 8-minute rule, the assistant modifiers, and the threshold that stops the money.

Unit allocation math with worked examples, timed versus untimed codes, CQ and CO assistant modifiers, MPPR, the CY2026 KX threshold, and plan-of-care certification timing.

The Eligibility-First Revenue Defense: stop denials at the front desk, not the appeal queue.

270 and 271 transaction anatomy, verification cadence, coordination of benefits logic, and the 2026 Medicaid redetermination timeline that decides whether a claim was ever payable.

The Prior Auth Command Center: run authorization as a pipeline, not a pile of faxes.

Intake triage, payer portal automation, peer to peer escalation, and the CMS-0057-F deadlines that reshape prior authorization through 2027.

The AR Workdown Operating System: score the inventory, then work it like a factory.

Priority scoring by dollar, collectability, and timely filing risk. Payer tiered queues, caller productivity math, and the weekly melt cadence that clears aged AR.

The Authorization Ledger: utilization is the master metric of ABA revenue.

Approved hours quietly expire and never reach an aging report. The five-step ledger method that holds utilization at 85 to 95 percent, with zero lapsed authorization days.

The Payer You Cannot See: eligibility and coordination of benefits defense.

ABA episodes run for years while insurance changes silently. The monthly surveillance control that caps recoupment exposure at one month instead of twelve: birthday rule, court decrees, phantom terminations.

Unit Economics of the Session: ABA clean claim engineering.

A clean claim costs $1x, a rework $8x, an appeal $25x. The full 97151 to 97156 code family with credential tiers, unit math, and the checkpoints that hold first pass resolution at 96 to 98 percent.

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

Every state interprets the same CPT codes differently. Why expansion multiplies the rule surface faster than revenue, and the versioned rule library that replaces memory-based compliance.

The Escalation Ladder: ABA denial management as negotiation, not queue work.

Four rungs from payer representative to state regulator, with every concluded dispute converted into an upstream rule. Includes the regulatory case where 100 percent of denials were overturned.

2026 ABA Payer Policy Survival Guide for Billing.

The 2026 ABA payer policy playbook for CFOs and billing directors: Indiana 6% cut, NC HB 696, Vermont billing ban, Optum, Evernorth, BACB and TRICARE.

AHCCCS SUD Billing & Coding Field Guide.

Arizona Medicaid SUD and behavioral health billing reference: ASAM level to AHCCCS code crosswalk, per-diem and same-day rules, modifiers, authorization paths, and denial prevention.

V28 RAF Optimization Playbook for MA and VBC.

CMS-HCC V28 is 100% phased in for 2026. Fewer payment HCCs compress RAF. Fix it with chronic recapture, suspect funnels, MEAT, and AWV workflows.

DNFB to Cash: The 13-Week DNFB Compression Method.

Compress hospital DNFB from ~11 to ~4 days in 13 weeks: CDI rebuild, coding-queue rework, query turnaround, and a weekly cash-forecast cadence.

Credentialing as Revenue: Enrollment-to-First-Dollar.

Credentialing is the front of the revenue cycle. Measure enrollment-to-first-dollar days, run a provider pipeline with SLA stages, prevent revalidation lapses, and quantify revenue at risk from credentialing delay.

Denial Prevention Field Manual: 12 Root Causes.

First-pass denials run 10-12% and roughly 65% are never reworked. 12 denial root causes with CARC references, the front-end control and KPI for each.

The CMS V28 playbook for risk-adjustment coding teams.

Reference covering the 2,300 ICD-10 codes re-weighted under V28, the 200+ codes removed, the documentation gaps V28 punishes hardest, an 8-step migration timeline for MA and ACO REACH practices, suspect-generation methodology, the recapture window math, and how to stand up a 90-day V28 RAF lift program.

The three-way match handbook for ABA billing teams.

Operational reference on authorization tracking, supervision ratio enforcement, and EHR session note matching across 97151 through 97158. Includes the Pre-Flight Validator rules in plain language, the post-pay takeback math, and the audit pattern that prevents three-way match failures from ever reaching submission.

NCR over GCR: an honest collection framework for FQHCs.

FQHC finance reference. Why GCR misleads under PPS. How to calculate NCR by payer class. AR aging on date-of-service. UDS Table 9 alignment. Wrap reconciliation discipline. The four payer streams that have to be split apart and how to report each one honestly to your CFO and your board.

The 80 denial patterns reference for RCM operations.

Reference cataloging 80 active denial root causes across commercial, Medicaid, and Medicare Advantage. Per pattern: CARC/RARC, payer concentration, prevention rate, recommended correction, dollar exposure benchmark. Built from 18 months of multi-specialty remit analysis. Use it as a training reference for AR teams or as a coding upstream audit checklist.

Cutting BCBA credentialing from 97 days to 22.

Credential OS reference. Parallel commercial and Medicaid pipelines, NPPES auto-enrich, BACB lookup, Pre-Flight Validator rule library, Revenue-at-Risk dollar math. A roadmap to sub-30-day TAT for any ABA chain. Includes the 14-state engagement sample where 38 BCBAs reached a 22-day median time to bill.

A revenue cycle field guide for FQHCs and safety-net hospitals.

Why blended Gross Collection Rate lies under PPS, the four payer streams that have to be split apart (Medicaid PPS, FFS Commercial, FFS Medicare, Self-Pay/Sliding), the rate-letter keystone, internal versus external levers, an anonymized 30-day diagnostic walkthrough on a behavioral-health-heavy FQHC, and eight operating disciplines that separate a 92 percent realized FQHC from a 73 percent one.

A field guide to payer credentialing for new California physician groups.

Why credentialing is harder than it looks, the pipeline framework (commercial, Medicare, Medi-Cal, regional), the Medicare Part B keystone, internal versus external levers, a real case in point, what good execution looks like, and the revenue windows you can hit in year one.