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Showing posts with the label Texas Skilled Nursing Facility Billing

What Is the CY2026 Efficiency Adjustment and How Does It Impact Internal Medicine Billing?

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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...

Texas SNF Medical Billing Outsourcing: Year-End Revenue Challenges & Solutions

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  Why Texas Skilled Nursing Facilities Need RCM Support at Year-End As the year ends, Skilled Nursing Facilities (SNFs) across Texas face high operational pressure—increased patient volumes, PDPM billing complexities, and Medicaid authorization challenges. More than 76% of Texas SNFs experience cash flow delays due to claim denials and backlog in Aging AR . Meanwhile, insurers and government payers tighten audits and documentation checks, increasing payment risk for the facilities. This is where partnering with an experienced medical billing company  becomes crucial. Texas SNF Billing Challenges Right Now Texas SNFs are dealing with: • Medicaid Managed Care claim confusion and authorization errors • Delays in reimbursement due to PDPM documentation gaps • Labor shortages affecting billing and follow-ups • Increased scrutiny from Texas Health & Human Services (HHSC) on compliance • High volume of 60–120+ days Aging AR stuck in payer queues These problems lead...