Xpert Billing Blog https://humanmedicalbilling.com/blog/ Expert RCM insights and healthcare compliance updates by Kara Wily. en-US ©2025 Human Medical Billing. All rights reserved. info@humanmedicalbilling.com (Kara Wily) info@humanmedicalbilling.com (Human Medical Billing) Sun, 18 May 2026 00:00:00 +0000 60 hourly 1 https://humanmedicalbilling.com/images/xpertblog/kara-wily-human-medical-billing-business-strategist-and-author.webp Xpert Billing Blog https://humanmedicalbilling.com/blog/ 144 144 CMS Names 29 Early Adopters for Electronic Prior Authorization Before 2027 https://humanmedicalbilling.com/blog/cms-names-29-early-adopters-for-electronic-prior-authorization-before-2027/ https://humanmedicalbilling.com/blog/cms-names-29-early-adopters-for-electronic-prior-authorization-before-2027/ Sun, 18 May 2026 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS announces 29 healthcare organizations as early adopters for electronic prior authorization ahead of January 2027 requirements. Learn how this affects your practice. Beginning with the announcement by CMS of 29 healthcare organizations as "Early Adopters" under the Electronic Prior Authorization Acceleration Initiative, the organization is working on a cross-sector collaboration model involving a combination of health systems, EHR developers, physician practices, and digital-health companies to identify workflow challenges and technology issues that will need to be resolved before the electronic prior authorization requirements take effect in January 2027.

]]> Medicaid Noncitizen Funding Ends Oct. 1: What Providers Must Do Now https://humanmedicalbilling.com/blog/medicaid-noncitizen-funding-ends-oct-1-what-providers-must-do-now/ https://humanmedicalbilling.com/blog/medicaid-noncitizen-funding-ends-oct-1-what-providers-must-do-now/ Wed, 07 May 2026 00:00:00 +0000 Kara Wily Medicaid Policy & Impact CMS ends federal Medicaid matching funds for refugees, asylees, and parolees Oct. 1, 2026. Learn how to protect reimbursement before the deadline. On April 8th, 2026, CMS issued State Health Official letter SHO #26-001 to instruct state agencies to discontinue claiming federal Medicaid & CHIP matching monies for all lawfully present noncitizens, effective October 1, 2026. This directive was enacted under Section 71109 of the Working Families Tax Cut legislation (Public Law 119-21). Refugees, asylees, parolees, trafficking victims, etc. (non-citizens) that are receiving full Medicaid coverage NOW will LOSE federal funding eligibility within six months.

]]> NCCI Q3 2026 Add-On Code Edits: What Changes July 1 https://humanmedicalbilling.com/blog/ncci-q3-2026-add-on-code-edits-what-changes-july-1/ https://humanmedicalbilling.com/blog/ncci-q3-2026-add-on-code-edits-what-changes-july-1/ Tue, 05 May 2026 00:00:00 +0000 Kara Wily HCPCS, CPT & Code Updates CMS published NCCI Q3 2026 add-on code edits effective July 1. Learn what changed for AOC pairings and the ESRD AX modifier before claims are denied. CMS released the Q3 2026 version of the NCCI Add-on Codes (AOC) edit update on April 20, 2026. This edit is scheduled for implementation on July 1, 2026. The NCCI AOCs determine which add-on procedures can be billed in conjunction with primary services under Medicare Part B. Any changes to these pairs may result in CO-97 denial if the claims scrubber has not been updated.

]]> EHR vs EMR: Why the Difference Affects Your Billing https://humanmedicalbilling.com/blog/ehr-vs-emr-why-the-difference-affects-your-billing/ https://humanmedicalbilling.com/blog/ehr-vs-emr-why-the-difference-affects-your-billing/ Tue, 29 Apr 2026 00:00:00 +0000 Kara Wily Coding & Documentation EMR and EHR aren't the same and for billing teams, the difference affects MIPS scores, clean claims, and CMS compliance. Here's what to know. Most healthcare providers treat EHR and EMR as the same term, yet they are not the same. That confusion can have very real billing implications. An Electronic Medical Record (EMR) is a digitized version of an individual provider's paper medical record - valuable to that provider within their own clinical setting but unable to be accessed by other providers outside of that environment.

]]> HETS EDI Attestation Due May 11: No Attestation, No Eligibility https://humanmedicalbilling.com/blog/hets-edi-attestation-due-may-11-2026-no-attestation-no-eligibility/ https://humanmedicalbilling.com/blog/hets-edi-attestation-due-may-11-2026-no-attestation-no-eligibility/ Fri, 24 Apr 2026 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS requires HETS EDI enrollment attestation by May 11, 2026. Miss it and Medicare eligibility checks get rejected. Here's what to do now. As a provider using a clearinghouse or vendor for Medicare eligibility verification, you have a firm deadline looming. On May 11, 2026, CMS plans to roll out a new HETS trading partner management system, and all providers must be enrolled in the system by submitting a HETS EDI enrollment attestation prior to that date.

]]> Q2 2026 HCPCS Update: 36 New Codes Billers Must Know Now https://humanmedicalbilling.com/blog/q2-2026-hcpcs-update-36-new-codes-billers-must-know-now/ https://humanmedicalbilling.com/blog/q2-2026-hcpcs-update-36-new-codes-billers-must-know-now/ Thu, 23 Apr 2026 00:00:00 +0000 Kara Wily HCPCS, CPT & Code Updates The Q2 2026 HCPCS Level II update adds 36 new codes, 17 PLA codes, & 6 sleep apnea C-codes. Learn what changed & what your billing team must do now. The Q2 2026 HCPCS Level II update adds 36 new codes, 17 PLA codes, and 6 sleep apnea C-codes effective April 1, 2026. Learn what changed and what your billing team must do now to avoid claim errors and payment delays from outdated coding.

]]> CMS Anti-Fraud CRUSH Rule Puts Every Biller at Risk https://humanmedicalbilling.com/blog/cms-anti-fraud-crush-rule-puts-every-biller-at-risk/ https://humanmedicalbilling.com/blog/cms-anti-fraud-crush-rule-puts-every-biller-at-risk/ Wed, 22 Apr 2026 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS's CRUSH initiative is already revoking billing privileges & suspending payments. Learn what the CRUSH rule means for your practice and what to do now. CMS's CRUSH initiative is already revoking billing privileges and suspending payments. CRUSH — Comprehensive Regulations To Uncover Suspicious Healthcare — represents the largest CMS anti-fraud enforcement action to date, with 5,586 providers revoked and $5.7 billion in payments suspended in 2025 alone. Learn what the CRUSH rule means for your practice and what to do now.

]]> Medicaid Provider Tax Rule 2026: Get Ready for April 3 Deadline https://humanmedicalbilling.com/blog/medicaid-provider-tax-rule-2026-what-billing-teams-must-do-before-april-3/ https://humanmedicalbilling.com/blog/medicaid-provider-tax-rule-2026-what-billing-teams-must-do-before-april-3/ Fri, 13 Mar 2026 00:00:00 +0000 Kara Wily Regulatory Updates CMS finalized the Medicaid provider tax rule effective April 3, 2026. Learn what billing teams in affected states must do before compliance deadlines. CMS finalized the Medicaid provider tax rule effective April 3, 2026. Learn what billing teams in affected states must do before compliance deadlines. Discover how the closure of the Medicaid MCO tax loophole impacts reimbursement rates, state-directed payments, and RCM strategies in seven key states.

]]> 2026 Telehealth: Virtual Direct Supervision Now Permanent https://humanmedicalbilling.com/blog/2026-telehealth-virtual-direct-supervision-now-permanent/ https://humanmedicalbilling.com/blog/2026-telehealth-virtual-direct-supervision-now-permanent/ Tue, 10 Mar 2026 00:00:00 +0000 Kara Wily Regulatory Updates CMS made virtual direct supervision in telehealth permanent in the 2026 MPFS. Learn the new billing and compliance rules to protect your practice revenue. CMS made virtual direct supervision in telehealth permanent in the 2026 MPFS. Learn the new billing and compliance rules to protect your practice revenue. Discover why the permanent removal of frequency limits in facilities and the formalization of virtual "immediately available" standards fundamentally alter telehealth operations.

]]> RCM Vendor Cybersecurity Audits: 2026 HIPAA Requirements https://humanmedicalbilling.com/blog/rcm-vendor-cybersecurity-audits-2026-hipaa-requirements/ https://humanmedicalbilling.com/blog/rcm-vendor-cybersecurity-audits-2026-hipaa-requirements/ Thu, 05 Mar 2026 00:00:00 +0000 Kara Wily Regulatory Updates 2026 HIPAA updates mandate RCM vendor security verification. Discover why HITRUST and SOC 2 Type II certifications protect your practice. 2026 HIPAA updates mandate RCM vendor security verification. Discover why HITRUST and SOC 2 Type II certifications protect your practice. Learn why mandatory multi-factor authentication, end-to-end encryption, and 24-hour breach notifications are now essential for healthcare provider compliance.

]]> The End of Paper CLIA: Mandatory Digital Shifts in 2026 https://humanmedicalbilling.com/blog/the-end-of-paper-clia-mandatory-digital-shifts-in-2026/ https://humanmedicalbilling.com/blog/the-end-of-paper-clia-mandatory-digital-shifts-in-2026/ Mon, 02 Mar 2026 00:00:00 +0000 Kara Wily Regulatory Updates CMS ends paper CLIA on March 1, 2026. Use our guide to update Form CMS-116 and Pay.gov to avoid technical denials. Protect your lab revenue today. CMS ends paper CLIA on March 1, 2026. Use our guide to update Form CMS-116 and Pay.gov to avoid technical denials. Protect your lab revenue today. Discover why this mandatory transition to digital-only CLIA management creates immediate operational risks for laboratories and how to navigate the 5-step transition roadmap.

]]> Top 10 Revenue Cycle Management (RCM) Companies in Healthcare (2026) https://humanmedicalbilling.com/blog/top-10-revenue-cycle-management-rcm-companies-2026/ https://humanmedicalbilling.com/blog/top-10-revenue-cycle-management-rcm-companies-2026/ Wed, 25 Feb 2026 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Stop losing 12% to denials. Compare the top 10 RCM companies of 2026. See why Human Medical Billing wins with less than 2% denial rates. Stop losing 12% to denials. Compare the top 10 RCM companies of 2026. See why Human Medical Billing wins with less than 2% denial rates. Discover which RCM partner wins in 2026 based on denial rates, staff access, and contract terms.

]]> Medicare Advantage Enrollment 2026: SNP & Billing Guide https://humanmedicalbilling.com/blog/medicare-advantage-enrollment-2026-snp-billing-guide/ https://humanmedicalbilling.com/blog/medicare-advantage-enrollment-2026-snp-billing-guide/ Tue, 24 Feb 2026 00:00:00 +0000 Kara Wily Regulatory Updates Analyze Medicare Advantage Enrollment 2026. See why SNPs are growing, how major carriers shifted, and 3 billing tips for V28 risk adjustment. Analyze Medicare Advantage Enrollment 2026. See why SNPs are growing, how major carriers shifted, and 3 billing tips for V28 risk adjustment. Discover why major insurers are focusing on higher acuity SNP plans with richer risk-adjusted payment rates and more direct care management opportunities.

]]> What is POS 11 in Medical Billing? A Guide for Practices https://humanmedicalbilling.com/blog/what-is-pos-11-in-medical-billing-a-guide-for-practices/ https://humanmedicalbilling.com/blog/what-is-pos-11-in-medical-billing-a-guide-for-practices/ Fri, 13 Feb 2026 00:00:00 +0000 Kara Wily Coding & Documentation Understand POS 11 in medical billing and how it impacts your reimbursement. Learn the differences between POS 11, 22, 21, and telehealth rules. Understand POS 11 in medical billing and how it impacts your reimbursement. Learn the differences between POS 11, 22, 21, and telehealth rules. Discover why this two-digit code is essential for identifying services provided in a physician's office versus a hospital setting and how it affects professional fee rates.

]]> New PBM Transparency Requirements 2026: The Audit Guide https://humanmedicalbilling.com/blog/new-pbm-transparency-requirements-2026-the-audit-guide/ https://humanmedicalbilling.com/blog/new-pbm-transparency-requirements-2026-the-audit-guide/ Thu, 05 Feb 2026 00:00:00 +0000 Kara Wily Regulatory Updates Master the 2026 PBM transparency requirements. Learn how EBSA rules impact ERISA plans, expose hidden fees, & empower audits. Download free checklist! Master the 2026 PBM transparency requirements. Learn how EBSA rules impact ERISA plans, expose hidden fees, & empower audits. Discover how these new Department of Labor mandates aim to reduce costs for self-insured employers and patients by "turning the light on" in the pharmaceutical supply chain.

]]> Medicare 2026: Survival Guide for Private Practices & Hospitals https://humanmedicalbilling.com/blog/medicare-2026-survival-guide-for-private-practices-and-hospital-leaders/ https://humanmedicalbilling.com/blog/medicare-2026-survival-guide-for-private-practices-and-hospital-leaders/ Thu, 22 Jan 2026 00:00:00 +0000 Kara Wily Medicare & CMS Policy Medicare 2026 costs are up. See new Part B rates ($202.90) and permanent telehealth rules. Our billing guide helps solo and group practices protect cash flow. Medicare 2026 costs are up. See new Part B rates ($202.90) and permanent telehealth rules. Our billing guide helps solo and group practices protect cash flow from increased patient responsibility.

Expert Author: Kara Wily, RCM Expert.

]]> 2026 Payer Squeeze: Fed Rates & Medical Practice Revenue https://humanmedicalbilling.com/blog/2026-payer-squeeze-fed-rates-medical-practice-revenue/ https://humanmedicalbilling.com/blog/2026-payer-squeeze-fed-rates-medical-practice-revenue/ Tue, 20 Jan 2026 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Fed rate cuts in 2026 will lower insurer profits, leading to strict audits and denials. Learn how to protect your medical practice revenue from the squeeze. Fed rate cuts in 2026 will lower insurer profits, leading to strict audits and denials. Learn how to protect your medical practice revenue from the squeeze.

Expert Author: Kara Wily, RCM Expert.

]]> CMS DMEPOS Master List Update 2026: New Billing Rules https://humanmedicalbilling.com/blog/cms-dmepos-master-list-update-2026-new-billing-rules/ https://humanmedicalbilling.com/blog/cms-dmepos-master-list-update-2026-new-billing-rules/ Wed, 14 Jan 2026 00:00:00 +0000 Kara Wily Medicare & CMS Policy Jan 13 Update: CMS-6097-N expands the DMEPOS Required List. See which items need Face-to-Face & WOPD by April 13, 2026 to prevent payment denials. CMS-6097-N expands the DMEPOS Required List. See which items need Face-to-Face encounters & Standard Written Orders (WOPD) by April 13, 2026 to prevent payment denials.

Expert Author: Kara Wily, RCM Expert.

]]> Top 5 Medical Billing Companies in USA | (2026 Review) https://humanmedicalbilling.com/blog/top-5-medical-billing-companies-in-usa-2026-review-why-service-beats-software/ https://humanmedicalbilling.com/blog/top-5-medical-billing-companies-in-usa-2026-review-why-service-beats-software/ Tue, 13 Jan 2026 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy We reviewed the best medical billing companies in 2026. Compare top 5 firms on denial rates, fees, & contracts to find winner for your practice. We reviewed the best medical billing companies in 2026. Compare top 5 firms on denial rates, fees, & contracts to find winner for your practice. Discover why human oversight beats software bots.

Expert Author: Kara Wily, RCM Expert.

]]> PBM Spread Pricing Ban 2026: End of Hidden Pharmacy Costs? https://humanmedicalbilling.com/blog/pbm-spread-pricing-ban-2026-end-of-hidden-pharmacy-costs/ https://humanmedicalbilling.com/blog/pbm-spread-pricing-ban-2026-end-of-hidden-pharmacy-costs/ Tue, 06 Jan 2026 00:00:00 +0000 Kara Wily Compliance & Regulation New 2026 laws ban PBM spread pricing in key states like California. Learn how SB 41 and Medicaid reforms impact your medical billing and revenue cycle. New 2026 laws ban PBM spread pricing in key states like California. Learn how SB 41 and Medicaid reforms impact your medical billing and revenue cycle.

Expert Author: Kara Wily, RCM Expert.

]]> The 2026 Medicare Advantage Shift: Why Denials Will Spike https://humanmedicalbilling.com/blog/the-2026-medicare-advantage-shift-why-denials-will-spike/ https://humanmedicalbilling.com/blog/the-2026-medicare-advantage-shift-why-denials-will-spike/ Wed, 31 Dec 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy The 2026 Great Retreat left 2.9M seniors in limbo. Learn why Medicare Advantage denials are rising and how strict eligibility checks protect your cash flow. The 2026 Great Retreat left 2.9M seniors in limbo. Learn why Medicare Advantage denials are rising and how strict eligibility checks protect your cash flow.

Expert Author: Kara Wily, RCM Expert.

]]> What Is Denial in Medical Billing? Your Guide to Getting Paid Faster https://humanmedicalbilling.com/blog/what-is-denial-in-medical-billing-your-guide-to-getting-paid-faster/ https://humanmedicalbilling.com/blog/what-is-denial-in-medical-billing-your-guide-to-getting-paid-faster/ Mon, 29 Dec 2025 00:00:00 +0000 Kara Wily Denials & Collections Understand what is denial in medical billing and how to fix it. Discover causes and proven strategies to recover revenue. Understand what is denial in medical billing and how to fix it. Discover causes and proven strategies to recover revenue. Improve your practice's bottom line.

Expert Author: Kara Wily, Head of Business Development at Human Medical Billing. 23+ Years in U.S. Medical Billing and RCM Expert.

]]> New CMS Drug Pricing Models 2026: GLOBE & GUARD Explained https://humanmedicalbilling.com/blog/new-cms-drug-pricing-models-2026-globe-guard-explained/ https://humanmedicalbilling.com/blog/new-cms-drug-pricing-models-2026-globe-guard-explained/ Fri, 26 Dec 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS released the GLOBE and GUARD models December. See how these mandatory updates impact Medicare Part B & D reimbursement and billing in 2026. CMS released the GLOBE and GUARD models December. See how these mandatory updates impact Medicare Part B & D reimbursement and billing in 2026.

Expert Author: Kara Wily, RCM Expert.

]]> Medicare 2026 Skin Substitute Update: New Coverage & Billing https://humanmedicalbilling.com/blog/medicare-2026-skin-substitute-update-new-coverage-billing/ https://humanmedicalbilling.com/blog/medicare-2026-skin-substitute-update-new-coverage-billing/ Thu, 18 Dec 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Stay ahead of the Medicare 2026 Skin Substitute Update. Learn about the $127.14 flat rate, the 18 covered products, and vital LCD coding changes for 2026. Stay ahead of the Medicare 2026 Skin Substitute Update. Learn about the $127.14 flat rate, the 18 covered products, and vital LCD coding changes for 2026.

Expert Author: Kara Wily, RCM Expert.

]]> CPT 92960: Cardioversion Coding & Billing Guide [2026] https://humanmedicalbilling.com/blog/cpt-92960-cardioversion-coding-billing-guide-2026/ https://humanmedicalbilling.com/blog/cpt-92960-cardioversion-coding-billing-guide-2026/ Wed, 17 Dec 2025 00:00:00 +0000 Kara Wily Coding & Documentation Updated for 2026: Master CPT code 92960. Get the latest RVUs, correct modifiers, ICD-10 crosswalks, and denial prevention tips for cardioversion procedures. Updated for 2026: Master CPT code 92960. Get the latest RVUs, correct modifiers, ICD-10 crosswalks, and denial prevention tips for cardioversion procedures.

Expert Author: Kara Wily, RCM Expert.

]]> 2026 Short-Duration RPM Codes: The 16-Day Rule is Dead https://humanmedicalbilling.com/blog/2026-short-duration-rpm-codes-the-16-day-rule-is-dead/ https://humanmedicalbilling.com/blog/2026-short-duration-rpm-codes-the-16-day-rule-is-dead/ Mon, 15 Dec 2025 00:00:00 +0000 Kara Wily HCPCS, CPT & Code Updates The 16-day rule is dead. New 2026 RPM codes finally allow billing for 2-15 days. Stop losing revenue on acute care - get the new rules here. The 16-day rule is dead. New 2026 RPM codes finally allow billing for 2-15 days. Stop losing revenue on acute care - get the new rules here.

Expert Author: Kara Wily, RCM Expert.

]]> CMS Updates LCDS Version 5.1 & New Fall Injury Coding for 2026 https://humanmedicalbilling.com/blog/cms-updates-lcds-version-and-new-fall-injury-coding-for-2026/ https://humanmedicalbilling.com/blog/cms-updates-lcds-version-and-new-fall-injury-coding-for-2026/ Wed, 10 Dec 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Effective Jan 1, 2026, the CMS LCDS Version 5.1 Errata updates J1900 definitions for falls with major injury. Learn the rules to secure LTCH QRP compliance. Effective Jan 1, 2026, the CMS LCDS Version 5.1 Errata updates J1900 definitions for falls with major injury. Learn the rules to secure LTCH QRP compliance.

Expert Author: Kara Wily, RCM Expert.

]]> Medicare Inpatient-Only List Ends: 2026 CMS Rule & Impact https://humanmedicalbilling.com/blog/medicare-inpatient-only-list-ends-2026-cms-rule-and-impact/ https://humanmedicalbilling.com/blog/medicare-inpatient-only-list-ends-2026-cms-rule-and-impact/ Fri, 28 Nov 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS ends the Medicare Inpatient-Only List starting 2026. See which 285 codes change first, the 2028 timeline, and how to prevent billing denials now. CMS ends the Medicare Inpatient-Only List starting 2026. See which 285 codes change first, the 2028 timeline, and how to prevent billing denials now.

Expert Author: Kara Wily, RCM Expert.

]]> What is PCN on Insurance Card? https://humanmedicalbilling.com/blog/what-is-pcn-on-insurance-card/ https://humanmedicalbilling.com/blog/what-is-pcn-on-insurance-card/ Fri, 21 Nov 2025 00:00:00 +0000 Kara Wily Payer Policies Struggling with pharmacy denials? It might be your PCN code. Learn exactly what this number does, where to find it, and how to fix claim errors quickly. Struggling with pharmacy denials? It might be your PCN code. Learn exactly what this number does, where to find it, and how to fix claim errors quickly.

Expert Author: Kara Wily, RCM Expert.

]]> ACA Subsidy Extension: Will 2026 Premiums Explode? https://humanmedicalbilling.com/blog/aca-subsidy-extension-will-2026-premiums-explode/ https://humanmedicalbilling.com/blog/aca-subsidy-extension-will-2026-premiums-explode/ Wed, 19 Nov 2025 00:00:00 +0000 Kara Wily Compliance & Regulation Will ACA subsidy extension pass? Learn how the 2025 deadline impacts 2026 health insurance premiums, open enrollment, & patient costs in our expert guide. Will ACA subsidy extension pass? Learn how the 2025 deadline impacts 2026 health insurance premiums, open enrollment, & patient costs in our expert guide.

Expert Author: Kara Wily, RCM Expert.

]]> What Is Credentialing in Medical Billing? A Complete Guide 2025 https://humanmedicalbilling.com/blog/what-is-credentialing-in-medical-billing-a-complete-guide/ https://humanmedicalbilling.com/blog/what-is-credentialing-in-medical-billing-a-complete-guide/ Mon, 17 Nov 2025 00:00:00 +0000 Kara Wily Revenue Cycle Management (RCM) Fundamentals It's the process that gets you paid. This 2025 guide details the steps, how to prevent costly claim denials, & the critical credentialing vs. enrollment differences. It's the process that gets you paid. This 2025 guide details the steps, how to prevent costly claim denials, & the critical credentialing vs. enrollment differences.

Expert Author: Kara Wily, RCM Expert.

]]> Is Insurer Downcoding Legal? A 2025 State Law Guide https://humanmedicalbilling.com/blog/is-insurer-downcoding-legal-a-2025-state-law-guide/ https://humanmedicalbilling.com/blog/is-insurer-downcoding-legal-a-2025-state-law-guide/ Fri, 14 Nov 2025 00:00:00 +0000 Kara Wily Payer Policies New 2025 state laws in Arkansas, Virginia, & Ohio are fighting back against AI downcoding. Read full state-by-state guide & learn how to protect your practice. New 2025 state laws in Arkansas, Virginia, & Ohio are fighting back against AI downcoding. Read full state-by-state guide & learn how to protect your practice.

Expert Author: Kara Wily, RCM Expert.

]]> 2026 PFS 2.5% Efficiency Adjustment: Stealth Cut for Specialists https://humanmedicalbilling.com/blog/2026-pfs-2-point-5-percent-efficiency-adjustment-stealth-cut-for-specialists/ https://humanmedicalbilling.com/blog/2026-pfs-2-point-5-percent-efficiency-adjustment-stealth-cut-for-specialists/ Tue, 11 Nov 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy The 2026 PFS final rule adds a 2.5% efficiency adjustment, a stealth pay cut for procedural medicine. See how this RVU cut erases the 3.26% pay raise. The 2026 PFS final rule adds a 2.5% efficiency adjustment, a stealth pay cut for procedural medicine. See how this RVU cut erases the 3.26% pay raise.

Expert Author: Kara Wily, RCM Expert.

]]> Why Paying for Patient Financial Experience Is the New Competitive Edge for Small Medical Practices https://humanmedicalbilling.com/blog/why-paying-for-patient-financial-experience-is-the-new-competitive-edge-for-small-medical-practices/ https://humanmedicalbilling.com/blog/why-paying-for-patient-financial-experience-is-the-new-competitive-edge-for-small-medical-practices/ Thu, 06 Nov 2025 00:00:00 +0000 Kara Wily Practice Operations & Patient Financial Experience Clear billing, flexible payment plans, and digital payment options help small practices boost collections, reduce write-offs, and improve patient trust. Clear billing, flexible payment plans, and digital payment options help small practices boost collections, reduce write-offs, and improve patient trust.

Expert Author: Kara Wily, RCM Expert.

]]> Healthcare M&A in Q3 2025: How 367 Physician Deals Hit Billing https://humanmedicalbilling.com/blog/healthcare-m-and-a-in-q3-2025-how-367-physician-deals-hit-billing/ https://humanmedicalbilling.com/blog/healthcare-m-and-a-in-q3-2025-how-367-physician-deals-hit-billing/ Fri, 31 Oct 2025 00:00:00 +0000 Kara Wily Market & Industry Trends Q3 2025 record M&A surge saw 367 physician deals. Learn how this wave, driven by PE & value-based care, impacts medical billing, & coding. Q3 2025 record M&A surge saw 367 physician deals. Learn how this wave, driven by PE & value-based care, impacts medical billing, & coding.

Expert Author: Kara Wily, RCM Expert.

]]> 104-Minute Rule: Medicare vs CPT Critical Care Billing (2025) https://humanmedicalbilling.com/blog/104-minute-rule-medicare-vs-cpt-critical-care-billing-2025/ https://humanmedicalbilling.com/blog/104-minute-rule-medicare-vs-cpt-critical-care-billing-2025/ Thu, 30 Oct 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Guide to Medicare's 104-Minute Rule for critical care. Learn why CMS needs 104 min to bill 99292, not CPT's 75 min. Avoid compliance risks & revenue loss. Guide to Medicare's 104-Minute Rule for critical care. Learn why CMS needs 104 min to bill 99292, not CPT's 75 min. Avoid compliance risks & revenue loss.

Expert Author: Kara Wily, RCM Expert.

]]> Why Private Equity is Targeting Outpatient Cardiology https://humanmedicalbilling.com/blog/why-private-equity-is-targeting-outpatient-cardiology/ https://humanmedicalbilling.com/blog/why-private-equity-is-targeting-outpatient-cardiology/ Thu, 16 Oct 2025 00:00:00 +0000 Kara Wily Market & Industry Trends PE is targeting outpatient cardiology. Learn to manage deal risks, boost revenue, and secure your independence with optimized medical billing. PE is targeting outpatient cardiology. Learn to manage deal risks, boost revenue, and secure your independence with optimized medical billing.

Expert Author: Kara Wily, RCM Expert.

]]> Medicare Physician Fee Schedule Quarterly Update: What Providers Need to Know https://humanmedicalbilling.com/blog/medicare-physician-fee-schedule-quarterly-update-october-2025/ https://humanmedicalbilling.com/blog/medicare-physician-fee-schedule-quarterly-update-october-2025/ Tue, 14 Oct 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Discover the Medicare Physician Fee Schedule October 2025 update. Learn new CPT/HCPCS codes, updated payments, & smart denial reduction strategies. Discover the Medicare Physician Fee Schedule October 2025 update. Learn new CPT/HCPCS codes, updated payments, & smart denial reduction strategies.

Expert Author: Kara Wily, RCM Expert.

]]> How to Choose the Best Medical Billing Company: The Complete Guide for Healthcare Providers https://humanmedicalbilling.com/blog/how-to-choose-the-best-medical-billing-company-the-complete-guide-for-healthcare-providers/ https://humanmedicalbilling.com/blog/how-to-choose-the-best-medical-billing-company-the-complete-guide-for-healthcare-providers/ Wed, 08 Oct 2025 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Learn how to choose the best medical billing company. Compare costs, expertise, technology, and compliance to avoid common errors and boost revenue. Learn how to choose the best medical billing company. Compare costs, expertise, technology, and compliance to avoid common errors and boost revenue.

Expert Author: Kara Wily, RCM Expert.

]]> Medicare Advantage Plans 2026: Complete Guide to Changes, Costs, and How to Choose the Best Plan https://humanmedicalbilling.com/blog/medicare-advantage-plans-2026-complete-guide-to-changes-costs-and-how-to-choose-the-best-plan/ https://humanmedicalbilling.com/blog/medicare-advantage-plans-2026-complete-guide-to-changes-costs-and-how-to-choose-the-best-plan/ Fri, 03 Oct 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Discover Medicare Advantage plans 2026 updates, market changes, costs, and how to find the best plan. Learn tips for enrollment and billing. Discover Medicare Advantage plans 2026 updates, market changes, costs, and how to find the best plan. Learn tips for enrollment and billing.

Expert Author: Kara Wily, RCM Expert.

]]> Healthcare AI Adoption 2025: Providers Report 81% Revenue Surge https://humanmedicalbilling.com/blog/healthcare-ai-adoption-2025-providers-report-revenue-surge/ https://humanmedicalbilling.com/blog/healthcare-ai-adoption-2025-providers-report-revenue-surge/ Tue, 30 Sep 2025 00:00:00 +0000 Kara Wily Market & Industry Trends Discover how healthcare AI adoption 2025 delivers 81% revenue lifts, cuts costs, and boosts patient care. Learn proven AI-driven strategies and next steps. Discover how healthcare AI adoption 2025 delivers 81% revenue lifts, cuts costs, and boosts patient care. Learn proven AI-driven strategies and next steps.

Expert Author: Kara Wily, RCM Expert.

]]> UnitedHealthcare Medicare Advantage Referral Requirements 2026 Guide https://humanmedicalbilling.com/blog/unitedhealthcare-medicare-advantage-referral-requirements-2026-guide/ https://humanmedicalbilling.com/blog/unitedhealthcare-medicare-advantage-referral-requirements-2026-guide/ Fri, 26 Sep 2025 00:00:00 +0000 Kara Wily Payer Policies Learn about UnitedHealthcare Medicare Advantage referral requirements for 2026. Find out who needs referrals, which plans are exempt, timelines, and billing rules. Learn about UnitedHealthcare Medicare Advantage referral requirements for 2026. Find out who needs referrals, which plans are exempt, timelines, and billing rules.

Expert Author: Kara Wily, RCM Expert.

]]> AHA Coding Clinic Q3 2025: What Healthcare Providers and Billing Teams Need to Know Now https://humanmedicalbilling.com/blog/aha-coding-clinic-q3-2025-what-healthcare-providers-and-billing-teams-need-to-know-now/ https://humanmedicalbilling.com/blog/aha-coding-clinic-q3-2025-what-healthcare-providers-and-billing-teams-need-to-know-now/ Wed, 24 Sep 2025 00:00:00 +0000 Kara Wily Coding & Documentation Learn about 28 ICD-10-CM/PCS coding updates covering presymptomatic Type 1 diabetes, BMI coding, pulmonary embolism, pancytopenia, & CEU webinar. Learn about 28 ICD-10-CM/PCS coding updates covering presymptomatic Type 1 diabetes, BMI coding, pulmonary embolism, pancytopenia, & CEU webinar.

Expert Author: Kara Wily, RCM Expert.

]]> Medicaid Spending Cuts Impact Pediatric Care: America’s Hidden Healthcare Crisis https://humanmedicalbilling.com/blog/medicaid-spending-cuts-impact-pediatric-care-in-2025-americas-hidden-healthcare-crisis/ https://humanmedicalbilling.com/blog/medicaid-spending-cuts-impact-pediatric-care-in-2025-americas-hidden-healthcare-crisis/ Mon, 22 Sep 2025 00:00:00 +0000 Kara Wily Medicaid Policy & Impact Explore how proposed Medicaid funding cuts put pediatric healthcare of U.S. children at risk. Learn about access, provider impacts, and adaptation strategies. Explore how proposed Medicaid funding cuts put pediatric healthcare of U.S. children at risk. Learn about access, provider impacts, and adaptation strategies.

Expert Author: Kara Wily, RCM Expert.

]]> 2025 Internal Medicine Billing Trends: Guide by Human Medical https://humanmedicalbilling.com/blog/2025-internal-medicine-billing-trends/ https://humanmedicalbilling.com/blog/2025-internal-medicine-billing-trends/ Tue, 16 Sep 2025 00:00:00 +0000 Kara Wily Market & Industry Trends Discover key 2025 internal medicine billing trends including MIPS updates, chronic care management audits, denial prevention, AI & coding best practices. Discover key 2025 internal medicine billing trends including MIPS updates, chronic care management audits, denial prevention, AI & coding best practices.

Expert Author: Kara Wily, RCM Expert.

]]> The Critical Role of HCC Coding in Healthcare Today https://humanmedicalbilling.com/blog/the-critical-role-of-hcc-coding-in-healthcare-today/ https://humanmedicalbilling.com/blog/the-critical-role-of-hcc-coding-in-healthcare-today/ Mon, 15 Sep 2025 00:00:00 +0000 Kara Wily Coding & Documentation Discover why HCC coding is essential for accurate reimbursement and quality care. Learn best practices, audit tips, and how we supports your coding success. Discover why HCC coding is essential for accurate reimbursement and quality care. Learn best practices, audit tips, and how we supports your coding success.

Expert Author: Kara Wily, RCM Expert.

]]> 2025 CMS Physician Self-Referral Code Updates: (CPT/HCPCS) https://humanmedicalbilling.com/blog/2025-cms-physician-self-referral-code-updates-complete-cpt-hcpcs-guide/ https://humanmedicalbilling.com/blog/2025-cms-physician-self-referral-code-updates-complete-cpt-hcpcs-guide/ Fri, 12 Sep 2025 00:00:00 +0000 Kara Wily HCPCS, CPT & Code Updates Discover 2025 CMS Physician Self-Referral CPT/HCPCS updates: 130 code additions, 23 deletions, & ESRD drug updates for compliance. Discover 2025 CMS Physician Self-Referral CPT/HCPCS updates: 130 code additions, 23 deletions, & ESRD drug updates for compliance.

Expert Author: Kara Wily, RCM Expert.

]]> CMS Delays Medicare Advantage Unused Benefits Policy: Impact on Healthcare Providers https://humanmedicalbilling.com/blog/cms-delays-medicare-advantage-unused-benefits-policy-impact-on-healthcare-providers/ https://humanmedicalbilling.com/blog/cms-delays-medicare-advantage-unused-benefits-policy-impact-on-healthcare-providers/ Wed, 10 Sep 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS has delayed its mid-year alerts for unused supplemental benefits, giving Medicare Advantage plans more time to set up tracking, communication systems. CMS has delayed its mid-year alerts for unused supplemental benefits, giving Medicare Advantage plans more time to set up tracking, communication systems.

Expert Author: Kara Wily, RCM Expert.

]]> What is Revenue Cycle Management? | Complete RCM Guide https://humanmedicalbilling.com/blog/what-is-revenue-cycle-management-complete-rcm-guide/ https://humanmedicalbilling.com/blog/what-is-revenue-cycle-management-complete-rcm-guide/ Tue, 09 Sep 2025 00:00:00 +0000 Kara Wily Revenue Cycle Management (RCM) Fundamentals Explore the fundamentals of revenue cycle management in healthcare. Understand each step of the RCM, common challenges, & the impact of technology. Explore the fundamentals of revenue cycle management in healthcare. Understand each step of the RCM, common challenges, & the impact of technology.

Expert Author: Kara Wily, RCM Expert.

]]> CMS Expands Access to Catastrophic Health Insurance Plans Starting 2026 https://humanmedicalbilling.com/blog/cms-expands-access-to-catastrophic-health-insurance-plans-starting-2026/ https://humanmedicalbilling.com/blog/cms-expands-access-to-catastrophic-health-insurance-plans-starting-2026/ Fri, 05 Sep 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy CMS expands catastrophic health plan access in 2026. Find out how providers can prepare for changes in billing, eligibility, and revenue cycle management. CMS expands catastrophic health plan access in 2026. Find out how providers can prepare for changes in billing, eligibility, and revenue cycle management.

Expert Author: Kara Wily, RCM Expert.

]]> Cigna's New E/M Downcoding Reimbursement Policy: Oct 2025 https://humanmedicalbilling.com/blog/cignas-new-em-downcoding-reimbursement-policy-oct-2025/ https://humanmedicalbilling.com/blog/cignas-new-em-downcoding-reimbursement-policy-oct-2025/ Wed, 03 Sep 2025 00:00:00 +0000 Kara Wily Payer Policies Learn how Cigna’s new E/M downcoding policy starting October 2025 impacts CPT codes and reimbursements. Discover steps to protect revenue. Learn how Cigna’s new E/M downcoding policy starting October 2025 impacts CPT codes and reimbursements. Discover steps to protect revenue.

Expert Author: Kara Wily, RCM Expert.

]]> What is Medical Coding? https://humanmedicalbilling.com/blog/what-is-medical-coding/ https://humanmedicalbilling.com/blog/what-is-medical-coding/ Mon, 01 Sep 2025 00:00:00 +0000 Kara Wily Coding & Documentation Learn what medical coding is, why it matters in healthcare, & how coders use ICD-10, CPT, & HCPCS codes. Explore key roles, certifications, & future trends. Learn what medical coding is, why it matters in healthcare, & how coders use ICD-10, CPT, & HCPCS codes. Explore key roles, certifications, & future trends.

Expert Author: Kara Wily, RCM Expert.

]]> Medical Billing Services Cost California (2025) https://humanmedicalbilling.com/blog/medical-billing-services-cost-california-2025/ https://humanmedicalbilling.com/blog/medical-billing-services-cost-california-2025/ Fri, 29 Aug 2025 00:00:00 +0000 Kara Wily Practice Operations & Patient Financial Experience Learn key factors in California billing costs: staffing, payer mix, denials, and AI. See 2025 trends & how the right partner cuts expenses & ensures compliance. Learn key factors in California billing costs: staffing, payer mix, denials, and AI. See 2025 trends & how the right partner cuts expenses & ensures compliance.

Expert Author: Kara Wily, RCM Expert.

]]> What is Medical Billing? https://humanmedicalbilling.com/blog/what-is-medical-billing/ https://humanmedicalbilling.com/blog/what-is-medical-billing/ Thu, 28 Aug 2025 00:00:00 +0000 Kara Wily Revenue Cycle Management (RCM) Fundamentals Learn what medical billing is, why it matters, the billing cycle, common challenges, and how AI is transforming healthcare billing for accuracy and efficiency. Learn what medical billing is, why it matters, the billing cycle, common challenges, and how AI is transforming healthcare billing for accuracy and efficiency.

Expert Author: Kara Wily, RCM Expert.

]]> How Cutting After-Hours Charting Helps Reduce EHR Time for Doctors https://humanmedicalbilling.com/blog/how-cutting-after-hours-charting-helps-reduce-ehr-time-for-doctors/ https://humanmedicalbilling.com/blog/how-cutting-after-hours-charting-helps-reduce-ehr-time-for-doctors/ Tue, 26 Aug 2025 00:00:00 +0000 Kara Wily Practice Operations & Patient Financial Experience Discover how reducing after-hours EHR charting helps doctors save time, cut burnout, and improve workflow efficiency. do this 30/60/90-day roadmap. Discover how reducing after-hours EHR charting helps doctors save time, cut burnout, and improve workflow efficiency. do this 30/60/90-day roadmap.

Expert Author: Kara Wily, RCM Expert.

]]> Essential Medical Billing KPIs for 2025 for Revenue Cycle Profit https://humanmedicalbilling.com/blog/essential-medical-billing-kpis-for-2025-metrics-that-matter-for-revenue-cycle-success/ https://humanmedicalbilling.com/blog/essential-medical-billing-kpis-for-2025-metrics-that-matter-for-revenue-cycle-success/ Fri, 22 Aug 2025 00:00:00 +0000 Kara Wily Revenue Cycle Management (RCM) Fundamentals Learn the key medical billing KPIs for 2025 - days in A/R, clean claim rate, denial rate, and net collection rate that drive cash flow and revenue cycle growth. Learn the key medical billing KPIs for 2025 - days in A/R, clean claim rate, denial rate, and net collection rate that drive cash flow and revenue cycle growth.

Expert Author: Kara Wily, RCM Expert.

]]> How AI and Automation Are Revolutionizing Medical Billing Processes in 2025 https://humanmedicalbilling.com/blog/how-ai-and-automation-are-revolutionizing-medical-billing-processes-in-2025/ https://humanmedicalbilling.com/blog/how-ai-and-automation-are-revolutionizing-medical-billing-processes-in-2025/ Thu, 21 Aug 2025 00:00:00 +0000 Kara Wily Market & Industry Trends See why medical billing needed change, how AI and automation improve revenue cycles in 2025, with benefits, trends, adoption steps, and future outlook. See why medical billing needed change, how AI and automation improve revenue cycles in 2025, with benefits, trends, adoption steps, and future outlook.

Expert Author: Kara Wily, RCM Expert.

]]> CMS WISeR Model: Medicare’s AI-Powered Prior Authorization Test to Cut Waste in 2025 https://humanmedicalbilling.com/blog/cms-wiser-model-medicare-ai-powered-prior-authorization-test-to-cut-waste-2025/ https://humanmedicalbilling.com/blog/cms-wiser-model-medicare-ai-powered-prior-authorization-test-to-cut-waste-2025/ Wed, 20 Aug 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy In 2025, Medicare’s new AI-driven prior authorization test aims to cut wasteful spending, improve billing efficiency, and ease provider and patient challenges. In 2025, Medicare’s new AI-driven prior authorization test aims to cut wasteful spending, improve billing efficiency, and ease provider and patient challenges.

Expert Author: Kara Wily, RCM Expert.

]]> US Medical Billing 2025: Fees, Prior Auth, NSA, and Practical RCM Playbook https://humanmedicalbilling.com/blog/us-medical-billing-2025-fees-prior-auth-nsa-practical-rcm-playbook/ https://humanmedicalbilling.com/blog/us-medical-billing-2025-fees-prior-auth-nsa-practical-rcm-playbook/ Sat, 16 Aug 2025 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy US medical billing 2025 explained: fee schedule updates, CPT code changes, prior authorization rules, IDR issues, and a proven RCM playbook for providers. US medical billing 2025 explained: fee schedule updates, CPT code changes, prior authorization rules, IDR issues, and a proven RCM playbook for providers.

Expert Author: Kara Wily, RCM Expert.

]]> Medicare Advantage Home Visit Diagnosis Reforms: What Doctors Must Know in 2025 https://humanmedicalbilling.com/blog/medicare-advantage-home-visit-diagnosis-reforms-what-doctors-must-know-in-2025/ https://humanmedicalbilling.com/blog/medicare-advantage-home-visit-diagnosis-reforms-what-doctors-must-know-in-2025/ Thu, 14 Aug 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Dive into 2025 Medicare Advantage reform essentials - policy updates, telehealth tips, and billing strategies for compliance. FAQs included. Dive into 2025 Medicare Advantage reform essentials - policy updates, telehealth tips, and billing strategies for compliance. FAQs included.

Expert Author: Kara Wily, RCM Expert.

]]> How Medical Billing Services Protect Against Medicaid Cuts https://humanmedicalbilling.com/blog/how-medical-billing-services-protect-against-medicaid-cuts/ https://humanmedicalbilling.com/blog/how-medical-billing-services-protect-against-medicaid-cuts/ Thu, 12 Jun 2025 00:00:00 +0000 Kara Wily Medicaid Policy & Impact Learn how medical billing services help protect your practice from Medicaid cuts through cost savings and expert denial management. Learn how medical billing services help protect your practice from Medicaid cuts through cost savings and expert denial management.

Expert Author: Kara Wily, RCM Expert.

]]> Medicare Advantage Denials Threaten Revenue in 2025 https://humanmedicalbilling.com/blog/medicare-advantage-denials-threaten-revenue-in-2025/ https://humanmedicalbilling.com/blog/medicare-advantage-denials-threaten-revenue-in-2025/ Mon, 09 Jun 2025 00:00:00 +0000 Kara Wily Denials & Collections In 2025, Medicare Advantage denials are surging-fueling revenue loss and care delays. This growing crisis is straining RCM for U.S. providers. In 2025, Medicare Advantage denials are surging-fueling revenue loss and care delays. This growing crisis is straining RCM for U.S. providers.

Expert Author: Kara Wily, RCM Expert.

]]> Avoid No Surprises Act Penalties: Mid-Year 2025 Update https://humanmedicalbilling.com/blog/no-surprises-act-2025-penalties-update/ https://humanmedicalbilling.com/blog/no-surprises-act-2025-penalties-update/ Fri, 06 Jun 2025 00:00:00 +0000 Kara Wily Compliance & Regulation Learn how to stay compliant with the No Surprises Act in mid-2025. Avoid costly penalties with QPA, IDR, GFE, and gag clause enforcement tips. Learn how to stay compliant with the No Surprises Act in mid-2025. Avoid costly penalties with QPA, IDR, GFE, and gag clause enforcement tips.

Expert Author: Kara Wily, RCM Expert.

]]> $68 Billion Lost: Why In-House Billing Must Go https://humanmedicalbilling.com/blog/68-billion-lost-why-in-house-billing-must-go/ https://humanmedicalbilling.com/blog/68-billion-lost-why-in-house-billing-must-go/ Wed, 21 May 2025 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Hospitals lost $68 billion due to billing errors. Learn why in-house billing is failing and how outsourcing helps save money and reduce risks. Hospitals lost $68 billion due to billing errors. Learn why in-house billing is failing and how outsourcing helps save money and reduce risks.

Expert Author: Kara Wily, RCM Expert.

]]> The Trends Set to Reshape Behavioral Health Billing in 2025 https://humanmedicalbilling.com/blog/the-trends-set-to-reshape-behavioral-health-billing-in-2025/ https://humanmedicalbilling.com/blog/the-trends-set-to-reshape-behavioral-health-billing-in-2025/ Wed, 21 May 2025 00:00:00 +0000 Kara Wily Market & Industry Trends Here are the key trends in behavioral health billing, new CPT/HCPCS codes (G0560, G0553), telehealth policies & Medicare updates.2025 Here are the key trends in behavioral health billing, new CPT/HCPCS codes (G0560, G0553), telehealth policies & Medicare updates.2025

Expert Author: Kara Wily, RCM Expert.

]]> Q3 2025 PLA Code Updates: 23 New AMA Lab Tests to Know https://humanmedicalbilling.com/blog/q3-2025-pla-code-updates-23-new-ama-lab-tests-to-know/ https://humanmedicalbilling.com/blog/q3-2025-pla-code-updates-23-new-ama-lab-tests-to-know/ Thu, 15 May 2025 00:00:00 +0000 Kara Wily HCPCS, CPT & Code Updates 23 new PLA codes are now live for Q3 2025. See what AMA added, what got deleted, and how these updates impact billing. Stay compliant. 23 new PLA codes are now live for Q3 2025. See what AMA added, what got deleted, and how these updates impact billing. Stay compliant.

Expert Author: Kara Wily, RCM Expert.

]]> What’s Changing in Medicaid under the 2025 Reconciliation Bill? https://humanmedicalbilling.com/blog/whats-changing-in-medicaid-under-the-2025-reconciliation-bill/ https://humanmedicalbilling.com/blog/whats-changing-in-medicaid-under-the-2025-reconciliation-bill/ Tue, 13 May 2025 00:00:00 +0000 Kara Wily Medicaid Policy & Impact The 2025 Reconciliation Bill could reshape Medicaid with caps on extra payments, frozen provider taxes potentially affecting millions - learn how The 2025 Reconciliation Bill could reshape Medicaid with caps on extra payments, frozen provider taxes potentially affecting millions - learn how

Expert Author: Kara Wily, RCM Expert.

]]> MIPS 2025 Timeline: Deadlines You Can’t Afford to Miss https://humanmedicalbilling.com/blog/mips-2025-timeline-deadlines-you-cant-afford-to-miss/ https://humanmedicalbilling.com/blog/mips-2025-timeline-deadlines-you-cant-afford-to-miss/ Mon, 12 May 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Master the MIPS 2025 reporting timeline - key dates from Oct 1 2024 virtual-group kickoff to Mar 31 2026 submission. Master the MIPS 2025 reporting timeline - key dates from Oct 1 2024 virtual-group kickoff to Mar 31 2026 submission.

Expert Author: Kara Wily, RCM Expert.

]]> Medical Credentialing in 2025: New NCQA Rules You Must Know https://humanmedicalbilling.com/blog/medical-credentialing-in-2025-new-ncqa-rules-you-must-know/ https://humanmedicalbilling.com/blog/medical-credentialing-in-2025-new-ncqa-rules-you-must-know/ Thu, 08 May 2025 00:00:00 +0000 Kara Wily Revenue Cycle Management (RCM) Fundamentals Discover how Medical Credentialing in 2025 is changing with new NCQA standards, monthly monitoring, & federal compliance updates don’t risk falling behind. Discover how Medical Credentialing in 2025 is changing with new NCQA standards, monthly monitoring, & federal compliance updates don’t risk falling behind.

Expert Author: Kara Wily, RCM Expert.

]]> Value-Based Care in 2025: Lifeline or Liability for Your Practice? https://humanmedicalbilling.com/blog/value-based-care-in-2025-lifeline-or-liability-for-your-practice/ https://humanmedicalbilling.com/blog/value-based-care-in-2025-lifeline-or-liability-for-your-practice/ Mon, 05 May 2025 00:00:00 +0000 Kara Wily Market & Industry Trends Explore Value-Based Care in 2025. Learn how to manage financial impacts, opportunities, and strategies for your practice’s success. Explore Value-Based Care in 2025. Learn how to manage financial impacts, opportunities, and strategies for your practice’s success.

Expert Author: Kara Wily, RCM Expert.

]]> 2025 HIPAA Security Rule: Final Warning for Private Practices https://humanmedicalbilling.com/blog/2025-hipaa-security-rule-final-warning-for-private-practices/ https://humanmedicalbilling.com/blog/2025-hipaa-security-rule-final-warning-for-private-practices/ Fri, 25 Apr 2025 00:00:00 +0000 Kara Wily Compliance & Regulation The 2025 HIPAA Security Rule is here. MFA, encryption, & annual risk reviews are now mandatory. Is your private practice ready? Learn how to stay compliant. The 2025 HIPAA Security Rule is here. MFA, encryption, & annual risk reviews are now mandatory. Is your private practice ready? Learn how to stay compliant.

Expert Author: Kara Wily, RCM Expert.

]]> July 2025 HCPCS Update: These Codes will Cost You a lot! https://humanmedicalbilling.com/blog/july-2025-hcpcs-update-these-codes-will-cost-you/ https://humanmedicalbilling.com/blog/july-2025-hcpcs-update-these-codes-will-cost-you/ Thu, 24 Apr 2025 00:00:00 +0000 Kara Wily HCPCS, CPT & Code Updates July 2025 HCPCS code changes are here. Some are new, some gone, and some updated. Get ready now to avoid billing mistakes. July 2025 HCPCS code changes are here. Some are new, some gone, and some updated. Get ready now to avoid billing mistakes.

Expert Author: Kara Wily, RCM Expert.

]]> Out-of-Network Billing in 2025: What Doctor Needs to Know https://humanmedicalbilling.com/blog/out-of-network-billing-in-2025-what-doctor-needs-to-know/ https://humanmedicalbilling.com/blog/out-of-network-billing-in-2025-what-doctor-needs-to-know/ Fri, 04 Apr 2025 00:00:00 +0000 Kara Wily Payer Policies Stay ahead in 2025 with this guide to out-of-network billing. Learn key steps, legal insights, better rates, and how to manage OON claims effectively. Stay ahead in 2025 with this guide to out-of-network billing. Learn key steps, legal insights, better rates, and how to manage OON claims effectively.

Expert Author: Kara Wily, RCM Expert.

]]> Future of Telehealth at Risk? Deadline Extended Until September 2025 https://humanmedicalbilling.com/blog/future-of-telehealth-at-risk-deadline-extended-until-september-2025/ https://humanmedicalbilling.com/blog/future-of-telehealth-at-risk-deadline-extended-until-september-2025/ Thu, 20 Mar 2025 00:00:00 +0000 Kara Wily Practice Operations & Patient Financial Experience The Medicare telehealth extension is now until September 2025. Learn what’s changing, how it impacts providers, and what the future holds for virtual care. The Medicare telehealth extension is now until September 2025. Learn what’s changing, how it impacts providers, and what the future holds for virtual care.

Expert Author: Kara Wily, RCM Expert.

]]> Doctors vs. Private Equity – Healthcare legislation 2025 Explained https://humanmedicalbilling.com/blog/doctors-vs-private-equity-healthcare-legislation-2025-explained/ https://humanmedicalbilling.com/blog/doctors-vs-private-equity-healthcare-legislation-2025-explained/ Wed, 19 Mar 2025 00:00:00 +0000 Kara Wily Compliance & Regulation Get the latest updates on U.S. healthcare legislation for 2025, including Massachusetts HB 5159, California SB 351 & AB 1415, and Texas HB 2747 & SB 1595. Get the latest updates on U.S. healthcare legislation for 2025, including Massachusetts HB 5159, California SB 351 & AB 1415, and Texas HB 2747 & SB 1595.

Expert Author: Kara Wily, RCM Expert.

]]> Medical Billing for Multi-Specialty Practices – 5 Must-Know Hacks https://humanmedicalbilling.com/blog/medical-billing-for-multi-specialty-practices-5-must-know-hacks/ https://humanmedicalbilling.com/blog/medical-billing-for-multi-specialty-practices-5-must-know-hacks/ Tue, 25 Feb 2025 00:00:00 +0000 Kara Wily Practice Operations & Patient Financial Experience Tackle complex reimbursement, compliance, and coding quickly. Discover 5 expert strategies to simplify billing in your multi-specialty practice. Don't miss out. Tackle complex reimbursement, compliance, and coding quickly. Discover 5 expert strategies to simplify billing in your multi-specialty practice. Don't miss out.

Expert Author: Kara Wily, RCM Expert.

]]> Medical Billing vs. Medical Coding: What’s the Difference? https://humanmedicalbilling.com/blog/medical-billing-vs-medical-coding-whats-the-difference/ https://humanmedicalbilling.com/blog/medical-billing-vs-medical-coding-whats-the-difference/ Fri, 14 Feb 2025 00:00:00 +0000 Kara Wily Coding & Documentation Discover the key differences between medical billing and medical coding, their responsibilities, career paths, salaries, and certifications. Discover the key differences between medical billing and medical coding, their responsibilities, career paths, salaries, and certifications.

Expert Author: Kara Wily, RCM Expert.

]]> Denial Prevention Checklist: First-Time Approval Guaranteed! https://humanmedicalbilling.com/blog/denial-prevention-checklist-first-time-approval-guaranteed/ https://humanmedicalbilling.com/blog/denial-prevention-checklist-first-time-approval-guaranteed/ Wed, 12 Feb 2025 00:00:00 +0000 Kara Wily Denials & Collections Discover a proven denial prevention checklist to secure first-time claim approvals, reduce revenue loss, and enhance efficiency in medical billing. Discover a proven denial prevention checklist to secure first-time claim approvals, reduce revenue loss, and enhance efficiency in medical billing.

Expert Author: Kara Wily, RCM Expert.

]]> A New Overpayment Rule – CMS Changes the 60-Day Rule https://humanmedicalbilling.com/blog/a-new-overpayment-rule-cms-changes-the-60-day-rule/ https://humanmedicalbilling.com/blog/a-new-overpayment-rule-cms-changes-the-60-day-rule/ Fri, 07 Feb 2025 00:00:00 +0000 Kara Wily Medicare & CMS Policy Learn about the New Overpayment Rule and CMS's 60-Day Rule changes. Discover compliance requirements, penalties, and best practices. Learn about the New Overpayment Rule and CMS's 60-Day Rule changes. Discover compliance requirements, penalties, and best practices.

Expert Author: Kara Wily, RCM Expert.

]]> Medical Billing Services: What No One Tells You in 2025! https://humanmedicalbilling.com/blog/medical-billing-services-what-no-one-tells-you-in-2025/ https://humanmedicalbilling.com/blog/medical-billing-services-what-no-one-tells-you-in-2025/ Thu, 06 Feb 2025 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Facts about medical billing services in 2025! Discover hidden pitfalls, cost-saving secrets, and expert tips to boost revenue and stay compliant. Facts about medical billing services in 2025! Discover hidden pitfalls, cost-saving secrets, and expert tips to boost revenue and stay compliant.

Expert Author: Kara Wily, RCM Expert.

]]> The Role of Medical Billing in Revenue Cycle Management https://humanmedicalbilling.com/blog/the-role-of-medical-billing-in-revenue-cycle-management/ https://humanmedicalbilling.com/blog/the-role-of-medical-billing-in-revenue-cycle-management/ Fri, 31 Jan 2025 00:00:00 +0000 Kara Wily Revenue Cycle Management (RCM) Fundamentals Discover the 10 steps of the medical billing revenue cycle, why it's vital to RCM, and tips to prevent billing issues. Read now! Discover the 10 steps of the medical billing revenue cycle, why it's vital to RCM, and tips to prevent billing issues. Read now!

Expert Author: Kara Wily, RCM Expert.

]]> Top Medical Billing Trends to Watch in 2025 https://humanmedicalbilling.com/blog/top-medical-billing-trends-to-watch-in-2025/ https://humanmedicalbilling.com/blog/top-medical-billing-trends-to-watch-in-2025/ Mon, 27 Jan 2025 00:00:00 +0000 Kara Wily Market & Industry Trends Explore 2025's key medical billing trends, from AI and patient-centric billing to telehealth and cybersecurity. Stay ahead with practical tips. Explore 2025's key medical billing trends, from AI and patient-centric billing to telehealth and cybersecurity. Stay ahead with practical tips.

Expert Author: Kara Wily, RCM Expert.

]]> Medical Billing Challenges in California and How to Overcome Them https://humanmedicalbilling.com/blog/medical-billing-challenges-in-california-and-how-to-overcome-them/ https://humanmedicalbilling.com/blog/medical-billing-challenges-in-california-and-how-to-overcome-them/ Tue, 21 Jan 2025 00:00:00 +0000 Kara Wily Practice Operations & Patient Financial Experience Explore the unique medical billing challenges in California and find actionable strategies to streamline your billing processes. Explore the unique medical billing challenges in California and find actionable strategies to streamline your billing processes.

Expert Author: Kara Wily, RCM Expert.

]]> 12 Benefits of Outsourcing Medical Billing Services for Providers https://humanmedicalbilling.com/blog/12-benefits-of-outsourcing-medical-billing-services-for-providers/ https://humanmedicalbilling.com/blog/12-benefits-of-outsourcing-medical-billing-services-for-providers/ Wed, 11 Dec 2024 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Discover how outsourcing medical billing services can save money, reduce errors, improve cash flow, and enhance patient care. Discover how outsourcing medical billing services can save money, reduce errors, improve cash flow, and enhance patient care.

Expert Author: Kara Wily, RCM Expert.

]]> Human Medical Billing Helps Healthcare Providers Avoid MIPS (Medicare) Payment Penalties https://humanmedicalbilling.com/blog/human-medical-billing-helps-healthcare-providers-avoid-mips-medicare-payment-penalties/ https://humanmedicalbilling.com/blog/human-medical-billing-helps-healthcare-providers-avoid-mips-medicare-payment-penalties/ Tue, 22 Oct 2024 00:00:00 +0000 Kara Wily Medicare & CMS Policy Simplify MIPS reporting and avoid penalties. Human Medical Billing offers expert help and streamlined processes. Simplify MIPS reporting and avoid penalties. Human Medical Billing offers expert help and streamlined processes.

Expert Author: Kara Wily, RCM Expert.

]]> How Outsourcing Medical Billing Services Can Boost Your Practice’s Revenue https://humanmedicalbilling.com/blog/how-outsourcing-medical-billing-services-can-boost-your-practice-revenue/ https://humanmedicalbilling.com/blog/how-outsourcing-medical-billing-services-can-boost-your-practice-revenue/ Wed, 16 Oct 2024 00:00:00 +0000 Kara Wily Outsourcing & Billing Strategy Learn how to improve efficiency and enhance patient care. Discover the benefits, compare it to in-house billing, and find the right outsourcing partner. Learn how to improve efficiency and enhance patient care. Discover the benefits, compare it to in-house billing, and find the right outsourcing partner.

Expert Author: Kara Wily, RCM Expert.

]]>