Medical Billers and Coders

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Home Health Agencies: Here's Why PDGM Payments Keep Falling Short

- September 22, 2026

Home health agencies can provide the right care, submit claims on time, and still see Medicare reimbursement come in lower than expected. The reason is often not simply a billing error. Under the Patient-Driven Groupings Model (PDGM), reimbursement depends on several factors, including the patient's clinical characteristics, functional needs, comorbidities, timing of the period, and whether the period meets the requirements for a full 30-day payment. For 2026, CMS also finalized changes to PDGM case-mix weights, functional impairment levels, comorbidity adjustment subgroups, and Low-Utilization Payment Adjustment (LUPA) thresholds. CMS also finalized permanent and temporary payment adjustments for home health. That means a reimbursement drop deserves more than a quick review of the claim amount. The real question is: What changed between the care provided and the payment received? How PDGM Determines Home Health Payment PDGM uses a 30-day period of care rather than the older 60-day...

Should You Switch Billing Companies if Your Family Practice Denial Backlog Keeps Growing?

- September 21, 2026

A growing denial backlog is more than a billing department problem. For a Family Practice, it can mean delayed payments, increasing A/R, more staff time spent on rework, and revenue that becomes harder to recover as claims age. But a large denial backlog does not automatically mean you should switch billing companies. The better question is: Is your current billing company actually fixing the causes of denials, or is it simply working through the same problems every month? That distinction matters. The American Academy of Family Physicians (AAFP) recommends tracking denial rate alongside days in A/R and adjusted collection rate because these measures provide a clearer picture of revenue cycle performance. A practice can have acceptable overall A/R while still carrying a significant amount of older receivables. When Does a Denial Backlog Become a Serious Problem? Not every denial needs to be treated as a crisis. Some claims may require additional documentation, payer review, corrected c...

Are You Missing TCM Revenue After Hospital Discharges? A Primary Care Billing Guide

- September 18, 2026

A patient is discharged from the hospital, returns to the primary care practice, and the care team spends time reviewing the discharge summary, reconciling medications, coordinating follow-up, answering questions, and managing the next steps. Then the practice bills a regular office visit. That is where some primary care practices may be leaving legitimate TCM revenue unrecognized. Transitional Care Management (TCM) is designed to account for the work involved in managing a patient's transition from an inpatient setting back to the community. Medicare's TCM framework includes communication after discharge, medication reconciliation and management, care coordination, and a required face-to-face visit. For practices handling a high number of hospital discharges, the financial issue is not simply whether the practice knows about CPT 99495 and 99496. The bigger issue is whether the practice has a reliable process for identifying eligible patients, completing the required steps on t...

What Global Period Documentation Gaps Are Really Costing Multi-Surgeon General Surgery Groups

- September 17, 2026

For a multi-surgeon general surgery group, global period documentation can look like a small operational issue. A missing postoperative note, unclear transfer of care, incomplete procedure detail, or poorly supported modifier may not seem significant on a single claim. Across dozens or hundreds of surgical cases, however, those gaps can create a much larger revenue-cycle problem. The issue is not simply whether a claim gets denied. Poor global-period documentation can make it harder to determine what work was actually performed, which surgeon was responsible for that work, whether a service was included in the surgical package, and whether a separately reported service was properly supported. Medicare generally includes postoperative services within the payment for procedures assigned a 10-day or 90-day global period. For major surgery, the 90-day global period includes the day of surgery and the 90 days following it, along with the applicable preoperative period. For a multi-sur...

Why Your Practice's Credit Line Is Really a Symptom of a Broken A/R Engine

- September 16, 2026

A practice can be busy, profitable on paper, and still struggle to pay its bills on time. That is when a credit line starts looking like a solution. The practice uses borrowed money to cover payroll, vendors, technology, rent, or other operating expenses while waiting for insurance payments to arrive. The problem is that repeated dependence on a credit line can indicate something deeper: the practice is not converting earned revenue into cash quickly enough. The problem may not be a lack of revenue. It may be a broken accounts receivable (A/R) engine. When Revenue Exists but Cash Does Not A medical practice can generate significant charges every month without collecting that money efficiently. Claims can remain in A/R because of coding issues, payer delays, eligibility problems, authorization issues, claim rejections, denials, underpayments, or weak follow-up. The result is a growing gap between services provided and cash received. When that gap becomes large enough, leadership m...

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