Medical Billers and Coders

For family practices, 2026 is not simply another year of Medicare payment updates. Changes to physician reimbursement are creating different financial effects depending on where and how care is delivered. That raises an important question for practice owners and administrators: Is your family practice reimbursement model positioned to benefit from CY2026 payment changes, or is it absorbing the downside? The answer depends on more than the headline Medicare conversion factor. Practice location, service mix, site of service, payer mix, coding, and revenue-cycle performance can all influence the actual financial outcome. Understanding these differences can help family practices make better decisions about staffing, service delivery, coding, and billing operations. The CY2026 Payment Environment Is Not Uniform A common mistake is to look at a Medicare payment update and assume every family practice will experience the same financial impact. That is rarely the case. Two family practices can...

If your primary care practice is still using HCPCS code G0511 , it is time to review your billing workflow. CMS ended the temporary allowance to bill G0511 for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) after September 30, 2025 . Beginning October 1, 2025, these organizations were required to report the individual CPT and HCPCS codes describing the applicable care coordination services instead of the single G0511 code. For 2026, this means G0511 should no longer be part of the standard billing workflow for these care coordination services. Practices that have not updated their systems may face claim rejections, incorrect billing, or lost reimbursement opportunities. For a detailed explanation of what replaced G0511, see What Replaced G0511? A Primary Care Guide to CY2026 APCM . Why G0511 Is No Longer the Right Billing Approach G0511 was previously used by RHCs and FQHCs as a general care management billing code. CMS changed this approach as part of its e...

The CY2026 Efficiency Adjustment is one of the important changes introduced under the 2026 Medicare Physician Fee Schedule. Effective January 1, 2026, CMS finalized a 2.5% reduction to the work RVUs of most non-time-based services . However, the adjustment does not apply broadly to every service billed by an internal medicine practice. Time-based services, including many evaluation and management (E/M) and care management services, are excluded. For internal medicine practices, understanding which services are affected is important because the adjustment can change reimbursement for certain procedures and ancillary services even when claims continue to process normally. For a detailed overview, practices can review What Is the CY2026 Efficiency Adjustment and How Does It Impact Internal Medicine Billing? . What Is the CY2026 Efficiency Adjustment? CMS finalized the efficiency adjustment as part of the CY2026 Physician Fee Schedule. The policy applies a -2.5% adjustment to the work comp...

The 2027 maternity billing changes will significantly alter how OBGYN practices report maternity care. Beginning January 1, 2027 , the CPT maternity care structure will move away from the traditional global model toward more detailed reporting across four phases: antepartum care, labor management, delivery, and postpartum care . The American Medical Association (AMA) has confirmed that 17 existing codes will be deleted, 12 new codes will be added, and six codes will be revised. For OBGYN practices, this is not simply a coding update. It can affect documentation, EHR workflows, charge capture, claims submission, payer contracts, reimbursement, AR, and denial management. Practices that begin preparing now will have more time to test their systems, train staff, review payer requirements, and identify potential revenue risks. For a broader explanation of the upcoming changes, see What Is the 2027 Maternity Billing Change and How Should OBGYN Practices Prepare? . Understand What Is Chan...

Internal medicine practices are facing increasing pressure to collect revenue from Medicare Advantage claims. While many practices focus on current claim submission and denial rates, an older problem can have an even greater impact on cash flow: legacy accounts receivable (AR) . Legacy AR consists of unpaid, denied, underpaid, or unresolved claims that remain outstanding for extended periods. When Medicare Advantage denials continue to accumulate, these older balances can quickly become difficult to recover. The problem is not simply that claims are being denied. Repeated denials can create additional follow-up work, delay reimbursement, increase write-offs, and push more balances into the 90-, 120-, and 180-day AR categories. For internal medicine practices, understanding the relationship between Medicare Advantage denials and legacy AR is essential for protecting collections and improving financial performance. What Is Legacy AR? Legacy AR refers to outstanding accounts that have rem...