Federally Qualified Health Centers are paid differently from every other provider type, and the three largest FQHC revenue losses are invisible to ordinary billing reports because each one involves money that was never claimed rather than claims that denied. The Medicaid Wrap-Around Payment Medicaid managed care plans pay FQHCs their negotiated rate – below the […]

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Every compliance program audits for overcoding. Almost nobody audits for the opposite – and in internal medicine, undercoding is usually the larger number. How Undercoding Happens Physicians who lived through payer audits learned to default to 99213. Since the 2021 E/M revisions, medical decision making or total time alone supports the level, and a visit […]

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Family practice runs on volume and thin margins, which makes complete charge capture the difference between a healthy year and a flat one. This guide covers the services family practices most often deliver and fail to bill in 2026. The Annual Wellness Visit Plus the Same-Day Problem Visit A Medicare patient arrives for an AWV […]

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Hospitalist groups run on thin professional-fee margins across high daily volume, which makes them uniquely exposed to billing losses that pay something and therefore never appear in a denial report. This guide covers the five that matter most for hospitalist and inpatient medicine practices in 2026. 1. Split/Shared Visits: The Silent 15% Haircut When a […]

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Family practices, internal medicine groups, hospitalist teams and multispecialty physician groups all watch the same dashboard: denial rate, clean-claim rate, days in A/R. Those numbers can look excellent while serious money leaves the practice every month. The reason is structural. Denials generate a work queue, so denials get worked. The five losses below never generate […]

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Update — August 2026: CMS finalized six new CPT codes in the 97X3X adaptive behavior family for 2027. The 90-day publish-to-payer window closes at year-end. If you bill ABA and haven’t started the crosswalk, you have compliance and revenue exposure right now. What Changes January 1, 2027 The current adaptive behavior CPT family (97151, 97153, […]

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