Resources · blog archive
Medical billing blog archive page 2 of 6
Earlier posts, newest first. Each one is written and reviewed by the billing team, works through a hypothetical example and lists the sources it rests on. The latest posts, the category list and the search box are on the first page of the medical billing blog.
Posts on page 2
- Coding and documentationThe 2026 KX modifier threshold: $2,480, the $3,000 review line and the note that supports bothThe 2026 KX modifier threshold for PT and SLP combined, the separate OT threshold and the targeted medical review line. When to add KX and what to chart.Updated Read
- Credentialing and enrollmentCAQH profile maintenance: the attestation cycle, what goes stale, and a quarterly routineCAQH profile maintenance: the reattestation cycle, the fields and files that go stale between attestations, and a quarterly routine to keep it current.Updated Read
- Denials and appealsThe Medicare 60-day overpayment rule: when the clock starts and how to refundThe Medicare 60-day overpayment rule in 42 CFR 401.305: when the clock starts, how a timely investigation suspends it, and how to report and return money.Updated Read
- Home care and home healthWhat the CY 2027 home health proposed rule means for your 30-day periodsCMS proposed a rise in CY 2027 home health payments after a 2026 cut, with a temporary adjustment still applied. The payment impact per period, worked out.Updated Read
- Payers and deadlinesMarketplace plans in 2026: fewer members, bigger deductibles and a 20% in-network denial rateHealthCare.gov insurers denied about a fifth of in-network claims in 2023, and enrollment fell in 2026. How to work ACA marketplace claim denials.Updated Read
- Practice operationsWhat AI actually does in medical billing today, according to the surveysMGMA polls show most medical groups used AI in visits by August 2026, yet many report work shifting, not shrinking. What the survey data means for billing.Updated Read
- Coding and documentationThe 2026 efficiency adjustment: which codes took the 2.5% work RVU cut, and which did notThe 2026 Medicare efficiency adjustment cut work RVUs for most procedures but spared time-based codes like E/M and care management. Who gained, who lost.Updated Read
- Denials and appealsHow to appeal a Medicare Part B denial: the five levels and their deadlinesMedicare Part B appeal deadlines run from the remittance for a redetermination, then from each decision after it. The five appeal levels and what to send.Updated Read
- Home care and home healthThe late NOA penalty: how one-thirtieth a day adds up, and how to stop the clockMedicare cuts a home health period payment by one-thirtieth for each day from the start of care until a late NOA is submitted. Arithmetic and exceptions.Updated Read
- Payers and deadlinesMedicare Advantage denials: how often appeals win, and why so few are filedKFF found most appealed Medicare Advantage denials were overturned in 2024, yet few were appealed at all. What the appeal rate means for your queue.Updated Read
- Practice operationsWhat a clearinghouse outage does to cash flow, and the contingency plan to write before the next oneA 2024 clearinghouse cyberattack halted claim flow and CMS offered accelerated and advance payments. The outage contingency plan that keeps claims moving.Updated Read
- Coding and documentationNCCI edits changed on October 1, 2026: how to check your top code pairsNCCI PTP edits v323r0 and new MUE values took effect on October 1, 2026. How to run your busiest code pairs against the new files before denials arrive.Updated Read
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