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Medicare, Medicaid & Compliance Guidelines
Medicare and Medicaid rules, coverage policies and compliance guidance explained for the people who have to follow them.
40 guides
DMEPOS Competitive Bidding: Status and Round 2028 Guide
Where the Medicare DMEPOS competitive bidding program stands in October 2026, the Round 2028 timeline and categories, and what it means for suppliers and referring practices.
HIPAA Compliance Checklist for Medical Practices (2026)
A HIPAA compliance checklist for medical practices, with the rule behind each item, the correct breach clocks and the status of the 2025 Security Rule proposal.
Upcoding in Medical Billing: Examples, Risks and Penalties
What counts as upcoding, when an honest coding error becomes a false claim, and what the law says about repayment and penalties, with a practical checklist for your practice.
Advance Beneficiary Notice (ABN): Form CMS-R-131 Guide for Providers
What an advance beneficiary notice is, when Medicare requires one, how to complete Form CMS-R-131, which GA, GX, GY or GZ modifier applies and how long to keep it.
Medicare Fee Schedule Changes for Pathology Billing, 2026-27
What CMS finalized for CY 2026, what it proposes for CY 2027, and how a pathology practice can model the effect on its own codes.
Surprise Medical Bills: What the No Surprises Act Means for Practices
A plain-language explainer of surprise medical bills: which services the No Surprises Act covers, what practices must disclose, and which of the three dispute paths applies.
Understanding SNF Billing Guidelines: A Comprehensive Guide
Discover essential SNF billing guidelines to enhance revenue cycle management and ensure timely reimbursements.
Medicare Sequestration: 2% Reduction, CARC 253 and Examples
Medicare still cuts fee-for-service payments by 2%. See how sequestration is calculated, how CARC 253 reads on a remittance and how to post it.
What Is MIPS in Healthcare? Categories, Scoring and Payments
A plain-English guide to MIPS: the four categories and weights, how the 0 to 100 final score is built and how Medicare payment adjustments are set.
Medicare Mental Health Reimbursement: How 2026 Rates Work
What Medicare pays for psychotherapy in 2026 depends on a formula, not one national number. See the 2026 conversion factors, the 90832-90837 time rules and the telehealth dates.
Medicare Physician Fee Schedule Changes: 2026 to 2027
The Medicare conversion factor rose for 2026 and is proposed to fall for 2027. Here is what is final, what is proposed, and how a practice can size its own...
Understanding Medicare Daily Rates for Skilled Nursing Facilities in 2024
Discover Medicare daily rates for Skilled Nursing Facilities, eligibility, costs, and future changes. Stay informed for better care decisions!
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