Orthopedics
The Brace Was Medically Necessary. Why Could Medicare Still Refuse Payment?
Primary Care / Internal Medicine
CMS Is Exploring New Approaches to Primary Care Payment. Is Your Practice Ready?
Medicare Participation for 2027: What Practices Should Review Before December 31
Once a year, practices that bill Medicare get a chance to revisit a decision that is easy to forget. From…
The January 2027 Prior Authorization API Deadline: What Practices Need to Test Now
January 1, 2027 is a little over nine weeks away. A number of summaries describe it as a deadline for…
The Payer Says “Network Closed.” Should Your Practice Stop Applying?
The letter arrives after weeks of waiting. The payer’s network, it says, is closed in your area. Many credentialing teams…
Quest Restores Quanum LSM After Cyber Incident: What Medical Practices Should Check Now
On October 26, Quest Diagnostics reported that it had remediated a cybersecurity incident and restored Quanum Lab Services Manager (LSM),…
The $72 Million Screening Gap: Why Medicare Provider Checks Need More Than One Database
A provider’s Medicare enrollment status can change. An organization’s ownership can raise questions about its eligibility for payment. And a…
The $1 Billion Medicare Fraud Case: What Billing Teams Should Check Before Submitting a Claim
A physician’s order may be signed, complete and ready to enter into a billing system. That does not, by itself,…
Medicare Appeals in 2027: When Is a Denial Worth Taking Further?
Every billing office has a stack of denials that sit in a gray zone: too large to write off without…
Virtual Medical Assistants: A Cheaper Front Desk or a New Operational Risk?
The usual way to pose this question is to compare a salary with a monthly vendor invoice. That comparison is…