Pain management practices performing the mild® (Minimally Invasive Lumbar Decompression) procedure should prepare for an important CPT coding update taking effect January 1, 2026.

Pain management practices performing the mild® (Minimally Invasive Lumbar Decompression) procedure should prepare for an important CPT coding update taking effect January 1, 2026.

The CPT 2026 update is one of the most sweeping revisions in recent years. With 418 CPT code changes scheduled to take effect on January 1, 2026, nearly every specialty will be impacted. Several high-volume, frequently used codes will be deleted or restructured, and many new codes come with updated documentation requirements.

The Q1 Downturn Isn’t Just Deductibles, It’s the Working Days You Lose That No One Plans For.A revenue cycle advisory memo from our VP of Revenue Cycle Management, Samantha Cable. Every year, physicians expect January to be slow because deductibles reset. That part is predictable. What most practices don’t realize is that deductibles are only one...

AI Is Transforming Medical Billing, But Human Oversight Keeps It SafeArtificial intelligence is becoming a core part of medical billing and coding. Tools that read documentation, predict denials, and automate repetitive tasks can reduce administrative load for busy practices. But here’s the key point:AI can make medical billing faster, but human...

The Hidden Cost of DIY Credentialing And Why It’s Slowing Your RevenueCredentialing Isn’t Just Forms. It’s Revenue Protection. Credentialing determines when a provider can start seeing patients, bill payers, and appear as in-network. When it’s handled as an afterthought or squeezed into an already busy schedule, things slip. And in credentialing,...

Understanding “Incident-To” and Supervision Rules: Why It Matters for Your PracticeStaying compliant with Medicare’s billing and supervision requirements is essential for every physician practice, not only to protect revenue but also to ensure proper documentation and audit readiness. In October 2025, Noridian Healthcare Solutions released...

Understanding the 2025 Medicare Updates for Facet Joint InterventionsUnderstanding the 2025 Medicare Updates for Facet Joint Interventions Based on Noridian Healthcare Solutions, LLC – October 2025 Webinar: “Harvesting Relief: Facet Joint Intervention for Pain Management” Many pain management providers are navigating new Medicare guidance that...

High-Level Medical Decision Making (MDM): How Accurate Documentation Impacts Compliance, Coding, and ReimbursementIn today’s healthcare landscape, evaluation and management (E/M) documentation is more than a formality, it’s the foundation for accurate coding, compliant billing, and fair reimbursement. Understanding how to properly...

Policy Alert: CMS Claims Hold UpdateEffective October 1, 2025 CMS has instructed all Medicare Administrative Contractors (MACs) to temporarily hold claims with dates of service October 1, 2025, and later for services affected by the expired Medicare payment provisions under the Full-Year Continuing Appropriations and Extensions Act, 2025. This...

Capture Modest but Meaningful Revenue with CPT 98966In today’s healthcare environment, practices can’t afford to overlook billable services, especially those that recognize the everyday work your non-physician providers are already doing. One such opportunity is CPT 98966, a simple code for short telephone assessment and management services....

Telehealth Waivers Set to Expire Sept. 30, 2025. Is Your Practice Ready?The countdown is on: Medicare’s current telehealth waivers are scheduled to end on September 30, 2025. Unless Congress takes additional action, physicians and practices will see a significant shift back to pre-pandemic Medicare telehealth rules. For many providers, this could...

Cigna & Aetna 2025 E/M Downcoding Policy: What Practices Need to KnowBeginning October 1, 2025, both Cigna and Aetna are launching new Evaluation & Management (E/M) reimbursement policies that could directly reduce payment for higher-level visits. These changes focus on downcoding Level 4 and 5 E/M services if the submitted documentation...

Prior Authorization and Pre-Claim Review: What ASC Providers Need to Know Medicare’s Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services is part of CMS’s broader effort to crush fraud and protect the Medicare Trust Fund.  Providers in California, Florida, Tennessee, Pennsylvania, Maryland, Georgia, and New York...

Capture New Revenue with G2211: Applies to All Specialties, the Chance to Capture an Extra $90K in RevenueStarting January 1, 2024, CMS activated a powerful new billing tool: HCPCS add-on code G2211. For physician practices, this represents both a way to capture work you’re already doing and a potential new revenue stream. What Is G2211? G2211 is...

WISeR Model: Preparing for Medicare Prior Authorization in 2026On January 1, 2026, CMS will launch the Wasteful and Inappropriate Services Reduction (WISeR) Model, a six-year demonstration designed to test technology-enhanced prior authorization in Medicare fee-for-service (FFS). This program introduces new Medicare prior authorization...

Don’t Wait for a RAC Audit to Discover Coding Errors. Here’s Why You Need a Proactive Coding Audit NowYou might think your medical coding is on point… claims are going out, payments are coming in, and no red flags are waving. But here’s the truth: Most practices don’t know they have a coding problem until it’s too late. That “wake-up call” often...

The Cost of Inaction: How Preventable Denials Quietly Drain Your Practice RevenueIn the fast-paced world of healthcare, many practice owners and administrators unknowingly accept revenue loss as part of daily operations. But what if much of that lost income was entirely avoidable? According to leading industry research, that's exactly the case...

5 Warning Signs Your Practice Has a Hidden Revenue LeakYou might think your practice is doing fine — bills are going out, payments are coming in, and the waiting room stays busy. But hidden revenue leaks could be costing you tens of thousands of dollars every year without you even realizing it. Unlike obvious billing mistakes, hidden leaks...

AI vs. Human Judgment in Healthcare: What’s at Stake?Is AI Denying Your Medical Claims? Watch Dr. Michael Dunn of the Arizona Medical Association discuss House Bill 2175 and the risks of AI-driven denials in healthcare.What the Doctor Says: A Quick Summary Dr. Michael Dunn raises concerns about insurance companies increasingly using artificial...

Klarna CEO Backtracks on AI: Why Human Expertise Still Matters in Revenue Cycle ManagementAI Promised Savings. Klarna Got a Headache. When Klarna’s CEO made global headlines for slashing costs using AI, the tech world took notice. But just months later, he’s reversing course—quietly rehiring humans to fix the problems AI couldn’t solve. Why?...

The True Cost of Inaction - Why In-House RCM is Costing You More Than You ThinkPicture this: You’re a busy physician running a successful pain management practice. Your patients trust you for their care, your team is dedicated, and your schedule is full. On the surface, everything looks great. But behind the scenes, your revenue cycle is...

5 Reasons Pain Management Clinics Struggle with Revenue—and How to Fix ItPain management practices work hard. Your schedule is packed, your providers are stretched thin—and yet, the revenue doesn’t reflect your effort. Sound familiar? You’re not alone. Even high-volume, high-quality practices are seeing slower reimbursements, increased denials,...

Every healthcare professional is devoted to bringing the best medical care to their clients. In order to do so, though, multiple aspects of their practice must align: staffing, equipment, and RCM. Revenue Cycle Management, however, requires very specific expertise and strategies. In the pursuit of maximizing reimbursement to be able to offer...

Worldwide, the healthcare industry is worth $12 trillion. In the United States, that number is $808 billion as of 2021. If we narrow the industry down to Houston, we find that it holds the largest medical complex in the world, employing over 376,000 healthcare workers. With such a large market, comes intense competition. This is where healthcare...

RCM services are pivotal to a sustainable medical practice. They are designed and implemented in order for healthcare providers to be reimbursed for the services they offer. Within revenue cycle management services, the electronic billing tools provide multiple benefits for professionals. Well-implemented RCM helps reduce costs, save time, and...

Medical practices, regardless of their size and specialty, encompass multiple aspects, one of which is practice management. It refers to the administrative responsibilities of daily operations and development of business strategies. Currently there are over 33,000 practice managers in the United States. The professions can be extremely...

Running the day-to-day of a medical practice like a well-oiled machine takes time and experience. Every practice is unique and knows which processes work well for them. The medical operations sector employs more than 700,000 people in the US alone. It takes a complex mix of skills and qualifications to become a physician practice operations...

A healthcare audit, expanding on Merriam Webster’s definition of “audit,” is a methodical examination and review of a healthcare organization. Although a priori rather daunting, in the ever-changing landscape of the healthcare industry, audits are essential. They drive innovation and optimize processes. Ultimately, as a result, revenue, customer...

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Healthcare consulting deals with organizations transitioning into the most streamlined end efficient versions of themselves. Here’s how.

Payer contracts in healthcare are vital, as they dictate the terms and conditions for medical services, coverage, and payment, between healthcare providers and payers. They are of high importance for your medical practice’s revenue and are the foundation of our healthcare system. Payers in the healthcare area are the different organizations, such...

Most practices are not equipped to handle the basic provider enrollment or contracting needs of today’s healthcare environment. If you are a new start-up practice, we can help get you on the right track from the beginning. The credentialing process and payer enrollment will ensure that you are ready to begin your practice. From starting your...

An effective process of revenue cycle management involves the coordination and optimization of various processes, from patient registration and billing to claims submission and reimbursement. Revenue cycle management ensures that healthcare providers receive timely and accurate payments for the services they provide, and it is crucial for the...

Credentialing plays a vital role in ensuring that healthcare providers meet specific standards of competence and quality. It is the process of verifying and evaluating the qualifications, experience, and professional background of healthcare professionals. Credentialing is crucial for maintaining patient safety and facilitating the provider's...

The healthcare industry is one of the most regulated sectors in the United States, and healthcare providers must comply with a plethora of regulations and standards to ensure the safety and well-being of their patients. Medical assistants, who play a critical role in the healthcare delivery system, are no exception. Credentialing is an essential...

The healthcare industry is constantly evolving, and healthcare providers must stay up-to-date with the latest developments to provide high-quality care to their patients. However, with the ever-changing landscape of healthcare, it can be challenging for providers to keep up with the latest trends and best practices. This is where a healthcare...

As a healthcare provider in Houston, Texas, managing the revenue cycle can be a complex and challenging process. Revenue cycle management (RCM) is the process of managing the financial aspects of patient care, from verifying patient eligibility and collecting copayments to submitting claims and following up on payments. Effective RCM is critical...

Revenue cycle management (RCM) is the process of managing the financial aspects of patient care, from verifying patient eligibility and collecting copayments to submitting claims and following up on payments.  Effective RCM is critical to maintaining the financial health of healthcare organizations in Houston, Texas, and ensuring they can...

A healthy payer mix is a vital metric for your medical practice because it affects the revenue stream and your bottom line. Every healthcare institution should track the payer mix and manage it carefully to adjust to the changing demands of the market. Read on to discover what a payer mix is, what a healthy managed payer mix looks like, and how...

A strategic revenue cycle management is vital for maximizing your reimbursement and ensuring the good financial well-being of your practice. However, it is a complex process with many opportunities for potential issues. That’s why healthcare administrators and other professionals have developed various automated procedures to help streamline...

Patients who come to your practice have one of many available health insurance plans. If you have signed a contract with a specific payor, your practice is in-network for people with an insurance plan from that payor. However, different insurance plans also determine whether the patients receive coverage for visiting in-network or out-of-network...

The healthcare industry is complex, and practice owners need help navigating through the changing landscape of the industry. It’s impossible to keep track of all the laws, regulations, policies, new medications, and procedures while still being able to run and manage a practice and attend to your patients. Luckily, healthcare consulting can make...

Digital marketing has become crucial for the success of many healthcare practices. It can help attract more patients, build a stronger relationship with them, and improve their satisfaction. Most of all, digital marketing helps medical professionals and practices thrive in today’s highly competitive healthcare industry. Read on to discover how to...

The Healthcare industry has become more competitive than ever. That’s why healthcare professionals and practices use different tools to gain an edge over their competition. For example, digital marketing is one of the most popular approaches, because it's one of the best ways to spread awareness about your medical services and attract more...

Make sure all Front Office Staff is prepared for January 2023. Each of these steps will help avoid issues within the Revenue Cycle.Patient Demographics Update: Verify patient address, phone number, email address and emergency contact information Verify Referring and/or PCP Information Verify ABN on file, if necessary Obtain new copies of driver...

Contracting is vital for any medical institution because it determines the type of relationship and reimbursement structure a practice can receive from the payer. It explains provider benefits, credentialing, medical necessities, reimbursement rates, schedules, and other things crucial for your medical practice. Read on to learn how to leverage...

The goal of any healthcare practice is to provide excellent patient care. To do that, you must optimize your revenue cycle and increase your medical billing efficiency. Here you can discover the three most important steps to maximize reimbursement and improve your practice’s financial well-being. Improve Claim Management The insurance providers...

The five P’s of healthcare digital marketing represent a strong base on which you can build your advertising strategy. Discover the five P’s of healthcare marketing and how they can help your medical practice. Patients Today’s patients are more interested in their health, but they are also bombarded with different information from all sides....

Payer contracts are vital for your medical practice’s revenue and are the foundation of our healthcare system. Negotiating a more favorable payer contract will help you improve your income potential, allowing you to provide better care to your patients. However, payers don’t necessarily reward loyalty with better payer contracts. That’s why you...

The healthcare credentialing process is vital for establishing frameworks and guidelines, and confirming that medical providers are competent to care for their patients. Every time a medical facility employs a new physician, nurse, or another healthcare practitioner, they must go through the medical credentialing process to verify their...

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What’s the Difference Between Payer Enrollment and Credentialing?Healthcare management is a complex field that requires special training and continuous education for the best results. Unfortunately, some new medical practices struggle to keep up with rules and regulations, and they often struggle to understand the difference between specific...

What Are the Types of Freestanding and Hospital-Based Ambulatory Care Services? Ambulatory care refers to diagnostic, preventative, and treatment services people receive in a facility and depart within the same day. This facility can be freestanding or connected to another medical practice, most commonly a hospital. Ambulatory care has evolved...

How Common Are Medical Billing Errors in Medical Claims? People tend to get anxious every time they have to open a medical bill. Considering the state of the US healthcare system, the medical bills often run in 5, 6, or even 7 figures. And there is a big question if your insurance is going to cover everything. People assume that healthcare...

What Is Credentialing in Healthcare? Not everyone can be a medical provider. You need to hold specific degrees, training, certifications, and other proof that you are able to practice medicine. Credentialing is a process that verifies you are competent and trained to provide care to patients seeking medical assistance. Credentialing also...

What Are the Office-Based Surgery Guidelines? As healthcare moves from traditional inpatient facilities like hospitals to outpatient settings, we observed a significant rise in office-based surgery procedures. Good regulation in this field was vital to prevent adverse effects and minimize the chances of negative health outcomes. An advance in...

What Type of Medical Practice Has the Greatest Shortage of Physicians? Physician shortages have been affecting America’s healthcare for decades. It is a widespread problem and contributes to limited patient access, worse patient care, increased physician burnout, and other issues. The alarming thing is that the demand for physicians is only...

What Is Payer Enrollment? Payer enrollment is the essential step in the revenue cycle of any healthcare organization. It refers to the process of joining a health insurance network, intending to be included in their provider plans.  However, many people underestimate just how complex and time-consuming this process can be. Inexperienced staff may...

Which Patients Are More Likely to Engage With Your Medical PracticeWhich Patients Are More Likely to Engage in Their Care? Patient engagement has become the main focus of modern healthcare. When healthcare practitioners manage to engage patients in their care, they are more likely to feel optimistic about the treatment, have higher self-esteem,...

Best Revenue Cycle Management Tools Good revenue cycle management is vital if you want to ensure your income stream runs smoothly and without hiccups. Today we have many tools that help you manage your revenue cycle and increase your profits. Read on to discover the most important features any revenue cycle software should have, and learn about...

How Can Technology Be Used to Engage Patients? People today rely heavily on technology for communication and access to information. Healthcare practitioners should take advantage of that and use technology to improve their patient engagement.  Improving patient interest and active participation in their treatment is a guaranteed way to better...

What is CMS (Centers for Medicare & Medicaid Services) in Healthcare?The Centers for Medicare and Medicaid Services (CMS) is an integral part of the US Department of Health and Human Services. The CMS runs Medicare, Medicaid, Children’s Health Insurance Programs (CHIP), and state and federal insurance marketplaces.  This federal agency provides...

Office closure OFFICE CLOSURE As a reminder, Peregrine Healthcare's offices will be closed onFriday, April 15, 2022in observance of Good Friday. Offices will resume normal hours onMonday, April 18th and all calls will be returned. Thank you! Let’s Connect Please complete the information below to receive a complimentary practice analysis or more...

Are Your Medical Billing Practices Healthy? (Quick Checklist)Each healthcare center relies on medical billing practices to keep a steady income flow. Setting up a good billing system can significantly improve the financial aspect of your medical practice and give you the freedom to commit to your patients entirely. Here, we present you with a few...

Patient Safety Procedures for Office-Based Surgeries We have seen an increase in procedures performed in physician offices in recent years, including office-based surgeries. The problem was that many states didn’t have strict guidelines for these types of operations, in contrast to surgeries performed in hospitals that had strict protocols and...

What Is Healthcare Management? The medical industry consists of more than physicians and nurses. There is personnel outside the operating room that does a vital job of managing a healthcare practice. Good healthcare management makes a medical facility more effective, profitable, and comfortable for patients and staff. So, what is healthcare...

The 5 Steps of Successful Revenue Cycle Management Revenue cycle management is a vital part of any successful healthcare practice. It is a unique system that allows healthcare businesses to streamline their revenue, from the initial contact with the patient to final payments. Revenue cycle management requires billing software, and healthcare...

What Are the Different Medical Practice Types? If you are a medical professional finishing education, specialization, or a training program and are looking to join or start a medical practice, there are several different options. You should get acquainted with each one to decide what’s the best course to reach your career goals. Here are the main...

What is Healthcare Revenue Cycle Management Healthcare is a relatively complex industry that uses several systems to make operations smoother. One of those systems is the revenue cycle, and it covers everything from the registration of a patient to their final payments. Revenue cycle management uses medical billing software, and it is the bridge...

How to Improve Patient Engagement in Healthcare? Many healthcare practices struggle to engage their customers and convince them to participate in their care plans. It doesn’t matter how good your expertise, experience, and medical procedures are if your patients struggle to understand them and fail to follow a treatment plan. That’s why many...

What Is Healthcare Consulting? Healthcare consulting helps various healthcare institutions navigate their business. The medical industry is fast-paced and evolving, and you need to ensure you are meeting all standards and requirements. For many healthcare providers, it is challenging to balance their patient care work with other business aspects....

What You Need to Know About Transitional Care from Hospital to Your Home Hospitals have transitional care practices to make it easier for patients to switch from the hospital environment to their homes. The goal of transitional care is to ensure the safety of patients during home-based treatment, reduce readmission rates, and prevent any negative...