The notice is a one-page form with one decision inside it. Used on the right service and coded with the right modifier, it moves a denied charge to the patient. Missed, it moves the charge to you.
When a patient moves from fee-for-service Medicare into a Medicare Advantage plan, the payer changes, the coverage rulebook changes, prior authorization appears, and the appeal ladder starts at the plan. Here is what changes and what the practice can still do about a denial.
Money a practice holds for a payer or a patient is a liability, not revenue. Here is how each credit balance gets created, what 42 CFR 401.305 requires, and the monthly review that clears it.
A 90-day AR cleanup is a project, not a pep talk. Here is how to pick the accounts, sequence them by deadline, name an owner for each, and write off what cannot be recovered.
A single case agreement is how an out-of-network practice gets paid at something like an in-network rate for one patient. Here is when payers grant one, what a request has to prove, and the terms that cost money when you leave them out.
A facility visit a physician and a nonphysician practitioner each contributed to is billed by one of them, and the rule that decides which one changed on January 1, 2024. The current test is time or medical decision making, the modifier is FS, and the record has to say who did what.
Denial rates fell again in 2026 while takebacks rose. Here is what a recoupment, an overpayment demand and a recovery auditor demand each let a payer do, and the Medicare windows that decide whether the money stays.
Place of service, modifier 95 or 93, and the level of the E/M service are where telehealth claims break. Here is what Medicare requires now, what runs through December 31, 2027, and what is permanent.
Four conditions decide whether a visit your nurse practitioner furnished can go out under the physician's number at 100 percent of the fee schedule. Miss one and the same visit reverts to the practitioner's own rate, which is the difference the OIG keeps auditing.
