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PECOS Surrogacy

Medicaid Eligibility Verification Mistakes That Hurt Reimbursement

If Medicaid eligibility denials are becoming a regular problem for your practice, you’re not alone. Across the country, medical practices are experiencing increased claim denials due to coverage changes, eligibility issues, coordination of benefits problems, and enrollment discrepancies. Following the end of continuous Medicaid enrollment protections, millions of beneficiaries have undergone eligibility redeterminations, increasing the […]
Workplace violence

Failing to Prevent Workplace Violence Could Cost You—Here’s How to Fix It Now

Workplace violence in healthcare isn’t rare anymore—and if you run a medical practice, you’re responsible for preventing it. This isn’t just about safety—it’s about compliance, liability, and protecting your team from real harm. If you ignore the risk, you’re exposing your practice to serious consequences. Under the Occupational Safety and Health Administration (OSHA), you are […]
Billing modifier 62

The Hidden Revenue Leaks in Global Surgical Billing (And How to Fix Them)

If you’re responsible for coding, billing, or managing revenue in a medical practice, understanding global surgical periods isn’t optional—it directly impacts your bottom line. Misunderstanding what’s included (and what’s not) leads to underbilling, denied claims, and lost revenue. The reality? Most practices leave money on the table simply because documentation and modifier usage don’t align […]

Protect Your Practice from Fraud, Waste and Abuse Violations

Compliance is no longer something your practice can afford to treat as a once-a-year training requirement. Government agencies continue to increase enforcement efforts targeting fraud, waste, and abuse in healthcare, and many investigations begin with issues that could have been prevented through better education, stronger oversight, and consistent compliance processes. The good news is that […]
PAHCOM

Navigating AI Tools in Practice Administration: Practical Steps for Small Practices in 2026

In the fast-paced world of medical practice management, 2026 has brought artificial intelligence (AI) from experimental buzz to everyday reality. For administrators in small to mid-sized independent practices—often juggling operations, billing, compliance, and staff coordination with limited resources—AI offers real relief from administrative burdens that contribute to burnout and inefficiencies. Recent surveys show physician AI […]
Children’s medical records

Top 10 Medical Records Strategies to Avoid Denials, Fines, and Legal Trouble

Your medical records are more than just files—they are your legal protection, your revenue support, and your compliance foundation. Every note, signature, and retention decision plays a role in whether your practice gets paid, passes audits, or faces penalties. If you’re not confident your team understands retention rules, destruction requirements, and compliance risks, this quick […]
downcoding-high-level-em

Why Your Level 4 and 5 E/M Claims Are Being Downcoded

Medical practices across the country are seeing a troubling trend: Level 4 and Level 5 Evaluation and Management (E/​M) claims are being denied, reduced, or quietly downcoded by payers and automated review systems. The frustrating part is that many providers do not realize it is happening until they notice lower reimbursement months later on remittance […]
Medicaid Audit

Medicaid Fraud Enforcement Is Getting More Aggressive — Here’s What You Need to Know

If you participates in Medicaid, Medicare, or managed care programs, your compliance risks are growing quickly. Federal agencies are dramatically increasing healthcare fraud enforcement efforts, and physician practices are now facing far more scrutiny around billing, eligibility verification, medical necessity, documentation accuracy, and reimbursement reporting. What used to be treated as a simple billing mistake […]
Angry patient

Front Desk Phone Tips to Protect Your Revenue

Your front desk team does far more than answer phones and schedule appointments. Every phone call can either improve collections, and protect your revenue — or create confusion, frustration, and unpaid balances. Many practices underestimate how important phone etiquette training really is. But the reality is simple: poor communication often leads to insurance errors, missed […]
Oig report

OIG Audit Priorities You Should Be Monitoring

If you manage a medical practice today, the federal government is already telling you where compliance investigations, audits, billing scrutiny, and improper payment reviews are heading next. The problem is that many physician practices are too busy handling staffing shortages, reimbursement cuts, payer denials, and operational fires to actually monitor those warning signs. That is […]