Medical Billing / RCM | Industry News | Medical Practice | CMS
If your practice bills Medicare, January 1, 2027 is coming with a pay cut attached. In July, CMS released its proposed 2027 Medicare physician fee schedule, and for most physicians the conversion factor drops 1.68%, from $33.40 to $32.84. Qualifying APM participants fare slightly better, with a 1.19% drop to $33.17. Most of the cut comes from the expiration of the one-time 2.5% bump Congress provided for 2026. Small statutory updates of 0.25% and 0.75% do not make up the difference. A 1.68% cut sounds small. For a specialty practice with tight margins, rising costs and a heavy procedure mix, it rarely lands as 1.68%. The question is not whether Medicare reimbursement cuts are coming. It is how much they will cost you, code by code. Want your number now? Estimate your 2027 Medicare impact with our free calculator.
Your lab processed ten thousand claims this month. A few hundred came back denied, not for bad science, but for a documentation gap nobody caught until the remit arrived.
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A wound care program had its billing dialed in for years. Debridement codes, skin substitute application, modifier pairing, all of it ran smoothly. Then January 1, 2026 arrived, and the revenue cycle team spent the next month relearning how to bill the exact same clinical work.
A wound care claim comes back denied. The clinician measured correctly, applied the right product, and followed the treatment protocol exactly. But the note describes the wound in words, and the payer's reviewer cannot verify wound depth, tissue type, or healing progression from a paragraph of text. Without a photo, the claim reads as unverifiable, not incorrect.
A patient comes in for a scheduled CGRP infusion, part of an ongoing chronic migraine treatment plan. The clinical visit goes exactly as planned. Three weeks later, the claim comes back denied because the infusion sequencing code and the primary drug code were billed out of order, and the payer's system flagged it as a duplicate rather than a coordinated administration.
Medical Billing / RCM | Laboratory
Molecular diagnostics continues to change what is possible in medicine. Genetic testing, next generation sequencing, biomarker testing and other advanced diagnostics are giving clinicians increasingly sophisticated information to help diagnose disease, guide treatment and support precision medicine.
The final quarter of 2026 is here, and laboratories have plenty to think about before January.
Ophthalmology billing is some of the most code-dense work in medicine. One busy clinic day can mix eye exam codes, E/M visits, imaging, injections with drug codes, and surgery inside a 90-day global period, and every one of them needs the right eye, the right modifier, and documentation to back it up.
About 25,000 eye care professionals will be at the Ernest N. Morial Convention Center in New Orleans for AAO 2026, October 9 to 12. Subspecialty Days run Friday and Saturday. The Opening Session is Saturday morning with Janet L. Davis, MD delivering the Jackson Memorial Lecture. Robert Wachter, MD is speaking on how AI is transforming healthcare. Monday closes with the Spotlight on Cataract.
Medical Billing / RCM | RCM | behavioral health
A counselor finishes back-to-back sessions and still has six treatment plans to update before the day ends. The billing team, three desks away, is fighting a stack of denials on claims for sessions that happened weeks ago. Neither problem is really about effort. Both trace back to the same source: behavioral health billing runs on rules that a general medical billing process was never built to handle.