Perspectives on where health operations are headed.
Analysis of what is changing, and guides that explain how things work. Written from the work, not the trend.
Analysis: What changed, who it affects and what to do about it. Dated, and revisited when rules change. Guides: Explains how something works, in plain English. Stays useful over time.
ICD-11 for US Health Organizations: What Changes, Where the US Stands, and What to Do Now
Much of the world is already working with ICD-11. US claims still run on ICD-10-CM, and no date is set. What is different, what is unresolved, and the preparation that pays off whichever way it goes.
Read moreAI Coding Tools and Rising Case Complexity: What the BCBSA Analysis Shows, and What It Doesn’t
Insurers say hospital AI coding added about $942 million in costs. Hospitals say the claims data cannot prove it. Both can be partly right, and both point to the same homework for any organization that uses AI in coding.
Read moreMedicare EDI and HIPAA Transactions Explained: 837, 835, 276/277, 270/271 and Acknowledgments
Every electronic claim is a conversation: you send an 837, and a series of replies tells you whether it got in, what happened to it and what you were paid. Here is what each HIPAA transaction does, how to read the three acknowledgments, who must bill electronically, and what changed recently.
Read moreNCCI Edits Explained: PTP Edits, MUEs, Modifiers and Add-On Code Edits
The National Correct Coding Initiative decides, line by line, which Medicare codes can be paid together, how many units are too many, and when a modifier is allowed to get past an edit. Here is how the three kinds of edit work, how to read a modifier indicator, which modifier to use, and what to do with a denial.
Read moreCMS-0057-F: What the Prior Authorization Rule Means for Providers Before January 2027
The rule puts its obligations on payers — faster decisions, specific denial reasons, public metrics and FHIR-based APIs. But the benefits reach only the providers who are ready to use them. Here is what is already in force, what arrives on January 1, 2027, and what to do now.
Read moreCY2027 Medicare Physician Fee Schedule: What RCM Teams Need to Model Before January 1
CMS’s proposed CY2027 rule cuts the conversion factor, rewrites same-day E/M billing, and locks remote monitoring to in-house staff — all ahead of a final rule due in November. Here’s what to model now, and what to hold off on until the ink is dry.
Read moreAgentic AI in US Health Systems: A Governance Checklist Before You Scale
Pilots are easy. Scaling an agent into revenue cycle or clinical documentation without a governance model is how a health system ends up explaining itself to compliance.
Read moreRegulatory Watch
Plain-English analysis of CMS and compliance changes that hit revenue cycle teams — when it matters, not weekly noise.
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