A psychiatrist documents a thorough 55-minute medication management session with a patient managing treatment-resistant depression. Clinically, nothing about the visit was ambiguous. On the claim, the time was rounded incorrectly against the CPT code's threshold, and the entire visit gets denied instead of downcoded, turning a billable encounter into unpaid work.
Medical Billing / RCM | Industry News | Genomic Testing | CMS
Key takeaways CMS's preliminary 2027 Medicare Clinical Laboratory Fee Schedule (CLFS) rates average a 16% weighted cut, with up to 15% per test on January 1, 2027. Nearly 1,200 tests are affected, and more cuts are scheduled for 2028 and 2029. CMS expects final rates in November 2026, the same month as the AMP 2026 Annual Meeting and Expo in Seattle. ACLA, CAP, the AHA and the Association for Molecular Pathology (AMP) are backing the RESULTS Act, which would freeze rates for 2027 and 2028. It has not passed yet. Labs that model their top-code exposure and fix denial and underpayment leakage now will absorb the cuts best. The October issue of Laboratory Economics led with the number lab leaders have been bracing for: an average weighted cut of 16% in CMS's preliminary 2027 CLFS rates. With final rates due in November and the molecular community meeting in Seattle for AMP 2026 (#AMP2026) the same month, the cuts will be the topic on the expo floor.
The Importance of Patient Engagement: Why They - And You - Need It
Learn why patient engagement is a necessity and how you can master it within your practice.
workers' Comp | Personal Injury
The wound care claim came back denied. Again. Not because the treatment was wrong. Because the note did not prove it was medically necessary. Now your biller is fighting an appeal, the workers' comp adjuster wants more paperwork, and the patient's attorney is asking why the file has not moved.
An EMG denial rarely says "wrong code." It says bundling, units, or medical necessity. By the time it lands, the study is done, the patient is gone, and your team is rebuilding the claim from memory.
Most podiatry practices lose money in Q4 the same way every year. Not through one big mistake, but through a dozen small ones that all come due at the same time: aging claims nobody worked, patient balances that roll into a new deductible year, and coding changes that never made it into the system.
Every laboratory has denials. The more useful question is why your laboratory keeps having the same ones.
Three days, one very loud expo hall, and more conversations about modifier 25 than any of us expected. ADS and Moyae just wrapped our first AAO together in New Orleans, and before the notes go cold, here is what ophthalmology practices were actually asking about.
It's October, and the questions start coming in. Did we start our Promoting Interoperability period in time? When was the last security risk analysis? Is our EHR still certified? And what exactly changes for neurology practices in 2027?
Wound care is one of the most valuable services a podiatry practice provides, and one of the easiest to lose money on. The care is usually right. The note is what fails. A missing depth measurement, an ulcer coded like a wound, or a debridement code that doesn't match the tissue removed is enough to turn a paid claim into a denial, a downcode, or a refund request after an audit.
Your billing manager pulls the aging report on a Friday afternoon. The EMG claims from three weeks ago are still sitting there. Two EEGs came back denied for medical necessity. An infusion claim bounced because the diagnosis code didn't match the one on the authorization. None of these were clinical mistakes. Every one of them was a billing problem.