How it works, in plain English.
Explanations of the codes, rules and systems behind health operations. They stay useful, and they are not sales material.
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 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 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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