HealthcareCompliance Archives |

ICD-10-CM April 2026 Update: What You Must Know

Leave a Comment / Medical Coding & Modifiers

The ICD-10-CM April 2026 Update introduces critical changes that directly impact medical billing accuracy and reimbursement outcomes. Although no new codes were added, the update significantly alters instructional notes, which can affect claim approvals and compliance. For practice managers, coders, and billing teams, ignoring the ICD-10-CM April 2026 Update can lead to claim denials, incorrect […]

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CPT Downcoding: Prevent Revenue Loss Fast

Leave a Comment / Medical Coding & Modifiers

Every healthcare provider and practice owner understands that financial stability depends on a healthy revenue cycle. However, one often overlooked issue quietly eroding reimbursements is CPT downcoding. This is not a minor billing adjustment—it is a systematic reduction in payment that can significantly impact cash flow and long-term profitability if left unaddressed. For practice managers

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Medicare Reimbursement: Reduce Delays & Denials

Leave a Comment / Medicare, Medicaid & Government Payers

In today’s U.S. healthcare environment, Medicare reimbursement optimization for healthcare practices is no longer optional—it is a financial necessity. As we move deeper into 2025 and prepare for 2026, the Centers for Medicare & Medicaid Services (CMS) has intensified oversight while implementing reimbursement pressures, including the 2.83% Physician Fee Schedule conversion factor reduction. For practice

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Locum Tenens vs Incident-to Billing Explained

Medicare Telehealth 2025: Avoid Payment Risk

Leave a Comment / Telehealth & Policy Updates

Healthcare providers, practice managers, and clinic owners face a major shift following the recent Medicare Telehealth Policy Changes 2025. The temporary flexibilities that made virtual care so accessible officially expired on October 1, 2025. Congress took no swift legislative action to extend the waivers. Consequently, the Centers for Medicare & Medicaid Services (CMS) reverted to

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Locum Tenens Billing Rules Every Practice Must Know

N472 Denial Code: Stop Duplicate Billing Errors

Leave a Comment / Denial Codes & Claim Fixes

If you’re a practice manager, healthcare provider, or clinic owner, you know how frustrating claim denials can be—especially the notorious N472 denial code. This code signals that another provider has already received payment for the service. This issue instantly stalls your revenue cycle and creates a cascade of administrative work. While this denial is frustrating,

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MA109 Denial: ASC Billing Fix Guide

GA Modifier UHC Claims: 4 Compliance Steps

Leave a Comment / Medical Coding & Modifiers

Starting February 1, 2025, a critical update from UnitedHealthcare (UHC) will reshape billing for certain commercial plan claims. Specifically, UHC will require the GA Modifier UHC Commercial Claims. This update is mandatory for services UHC may deem potentially non-covered. Consequently, healthcare providers, practice managers, and practice owners must act now. Missing the modifier or the

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Denial Code 198: Missing Precertification Fix Guide

Leave a Comment / Prior Authorization & Referrals

For healthcare providers, practice managers, and practice owners, few claim rejections are as common or as costly as those flagged with Denial Code 198 Missing Precertification. This denial is frustratingly simple: your claim was rejected because it lacked the required precertification, authorization, or notification for a specific service. Precertification, or prior authorization, is a mandatory

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