FizzTech Insights · 10 articles
Notes from thebilling desk.
Medicare rules, payer deadlines and coding changes, written for the people who run U.S. practices. We write about the problems that show up in claim queues, and every article links to the public source it relies on.
- CMS
- Federal Register
- KFF
- AMA
- MGMA
- HFMA
- eCFR
The FY 2027 ICD-10-CM codes take effect October 1
A new diagnosis code set arrives every October. Here is how to get a practice ready in the week that matters most, without memorizing the addenda.
- The FY 2027 ICD-10-CM code set applies to encounters from October 1, 2026 through September 30, 2027.
- Claims with deleted or invalid codes are rejected, and those rejections cluster in the first weeks of October.
The library
Showing 10 of 10
The FY 2027 ICD-10-CM codes take effect October 1
A new diagnosis code set arrives every October. Here is how to get a practice ready in the week that matters most, without memorizing the addenda.
Most appealed denials get overturned. Most denials are never appealed.
Medicare Advantage plans reversed more than 80% of the prior authorization denials that were appealed in 2024. Only about one denial in nine was appealed at all.
Prior authorization now runs on a clock
Since January, Medicare Advantage, Medicaid and CHIP plans have had to answer standard requests within seven days and urgent ones within 72 hours. Here is what changed at the front desk, and what did not.
Prior authorization has come to traditional Medicare in six states
The WISeR model puts technology companies between certain Original Medicare services and payment in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
Timely filing is the denial you cannot appeal
Most denials can be fixed. A claim that reaches the payer after its filing deadline usually cannot, and under most contracts the patient cannot be billed for it either.
Medicare telehealth has a new deadline: December 31, 2027
After years of short extensions and a lapse during the 2025 shutdown, Congress extended Medicare's telehealth flexibilities through the end of 2027. Here is what that settles for billing and what it does not.
Credentialing is a revenue problem that looks like paperwork
A provider who is not enrolled with a plan cannot bill it. Enrollment commonly takes two to four months, so the work has to start well before the start date.
The 2026 fee schedule, read from the practice side
Medicare's conversion factor went up, but a new efficiency adjustment and a one-year bump mean the increase is smaller and shorter than it looks.
When the clearinghouse went dark
The Change Healthcare cyberattack showed how one vendor outage can stop a practice's cash flow. This is the one-page contingency plan we think every practice should have.
Remote monitoring: shorter months finally count
Two new CPT codes for 2026 let practices bill remote physiologic monitoring for patients with 2 to 15 days of readings and for the first 10 minutes of management time.
These articles are general information for practice owners and managers. They are not legal, coding or compliance advice. Payer rules change and vary by plan and state, so check the current source before you act on anything here.
Have a question these did not answer?
Tell us what is going wrong with your claims. A short call is usually enough to see where the problem starts.