Practice Insider

The weekly read for people who run the practice, not just work in it.

One email a week for independent medical and dental practice owners. Specific numbers on billing, credentialing, compliance, and vendor selection — the kind of thing you usually only learn after it has already cost you. No filler, no vendor sales pitches.

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The archive

Past issues

Issue 17 · September 2026

The EHR export criterion has two halves, and only one has to run without the vendor

Why a certified EHR has to let a user run a single patient export at any time without calling the vendor, why the patient population export carries no such promise, the two April code sets that ended the once-a-year ICD-10-CM refresh, the website accessibility deadline that moved a year without moving the obligation underneath it, and the statute that forbids Medicare from paying an electronic claim inside 13 days.

Issue 16 · September 2026

The OSHA log a physician office can skip at any headcount, and the plan it cannot

Why a physician office can be outside the OSHA injury log at any headcount and still owe an annual safer device review and documented staff input in its Exposure Control Plan, the six month Medicare deactivation and the unpaid gap behind it, the opt-out affidavit that renews while patient contracts have to be signed again, and the in-office test that makes an exam room a CLIA laboratory.

Issue 15 · September 2026

The SBA rate ceiling drops 1.5 points at $350,000, and it attaches the day the application lands

Why the legal ceiling on a variable rate SBA 7(a) loan tightens by 1.5 percentage points once the loan crosses $350,000, the 30 day retrospective billing window Medicare opens only where circumstances precluded enrolling in advance, the software contract clause a certified health IT developer has to tell you it will not enforce, and the two percentages that decide what a non-participating practice may lawfully charge.

Issue 14 · August 2026

Two clocks run on every denied claim, and most practices only know about one

Why a duplicate or data-entry denial follows the reopening path instead of the appeal path, the 120 calendar day redetermination clock and the 5 day receipt presumption behind it, the 1 calendar year Medicare filing limit, the 60 day overpayment return rule and its 6 year lookback, and the clean-claim payment standards your state Medicaid agency has to meet.

Issue 13 · August 2026

The written estimate federal law already requires you to hand every self-pay patient

Why the growing self-pay share of your schedule carries a federal estimate obligation with a one business day deadline, what the $400 dispute threshold does to a bill already in collections, the records request that zeroes a quarter of a MIPS score, the Medicaid six month redetermination clock, and what a 2026 high deductible plan patient actually owes at the desk.

Issue 12 · August 2026

Four in five appealed Medicare Advantage denials were overturned, and nearly nine in ten denials were never appealed

Why the appeal rate on prior authorization denials is the number to fix first, the payer prior authorization metrics that became public documents in 2026, the virtual credit card fee that no plan can require you to accept, the Medicare revalidation deadline that stops payment outright, and the 2.5 points of the 2026 conversion factor that expire.

Issue 11 · August 2026

EHR list prices run $49 to $599 a month, and the vendors do not even agree on what the number measures

Why $49, $54, and $449 EHR stickers are priced in different units and only an all-in monthly total compares them, the six ransomware settlements since April that all cite one Security Rule provision, how to restate billing quotes before comparing, and the SBA maturity rule behind 25 year practice loans.

Issue 10 · August 2026

One payer is probably a third of your revenue — and the notice clause that turns that into a crisis

The share of net revenue tied to your single largest commercial payer, why the without-cause termination clause makes concentration urgent, the scheduling number that predicts new-patient loss before it shows up in volume, the HIPAA 60-day clock that starts at discovery, and the EHR uplift clause that reprices year five.

Issue 9 · July 2026

The multiple your next provider has to collect before the hire pays for itself — and the 85% rule that decides what an APP visit is worth

Why the break-even test on a new provider is a multiple rather than a salary and how to run it with your own overhead number, the loaded-cost multiplier that turns a base salary into the real expense line, the 85% Medicare rule on nurse practitioner and physician assistant claims and the hard conditions attached to billing incident-to instead, and the payer enrollment calendar that should set the start date.

Issue 8 · July 2026

The dashboard number that tells you how fast your money actually comes in — and the malpractice bill you only see when you leave

Why days in accounts receivable is the truest measure of how fast your practice actually gets paid and the two thresholds that flag trouble, the no-show rate that quietly caps revenue and the fix that recovers it, the malpractice tail-coverage bill you only see when you change carriers or retire, and the evergreen payer contract that never gives you a raise.

Issue 7 · July 2026

The revenue you delivered but never billed — and the number that catches the leak

Why missed charges quietly drain about 1% of net revenue and the number that catches them, what a paper statement really costs before a balance gets written off, the payer-recoupment lookback window you can push back on, and the occupancy-cost benchmark that flags a lease problem.

Issue 6 · July 2026

The fee-schedule setting that caps every claim below what your payers would pay — and the filing deadline that turns earned revenue into a write-off

Why a charge master set at or below your contracted rates caps every claim below what payers would actually pay, the payer timely-filing deadlines that turn earned revenue into un-appealable write-offs, the 60-day rule that makes an unrefunded overpayment a compliance problem, and the modifier that gets you paid for an E/M on the same day as a procedure.

Issue 5 · June 2026

Prior authorization is costing you a full staff day a week — and the 3% skim on every patient card payment

Why prior authorization quietly costs a full staff day a week and the one tracking habit that recovers it, the card-processing rate worth renegotiating, what front-desk turnover actually costs to replace, and the EHR data-export clause you only read when you leave.

Issue 4 · June 2026

The denial rate that writes off revenue you already earned — and the deadline that can freeze your Medicare pay

Why your initial denial rate is the revenue leak most small practices never measure, the five-year Medicare revalidation deadline that can freeze your billing privileges, the clearinghouse rejections that never show up as denials, and the free monthly OIG screening that prevents five-figure penalties.

Issue 3 · Week of June 15, 2026

The A/R number that warns you before your bank balance does — and the patient dollar you will never collect

The lead: why days in A/R and the over-90-day bucket warn you before your bank balance does, and how to read them. Plus three quick hits — collecting patient balances at the point of service, the real revenue cost of no-shows, and the support-staff ratio to benchmark before your next hire.

Issue 2 · Week of June 8, 2026

Your commercial contracts auto-renewed again — the 10-20 codes worth renegotiating

The lead: why your evergreen commercial contracts are stuck at old rates and which CPT codes are actually negotiable. Plus three quick hits — undercoding 99214 visits, real-time eligibility as denial prevention, and budgeting for malpractice tail coverage.

Issue 1 · June 2026

What your billing actually costs — and the credentialing mistake that stalls cash flow

Why net collection rate beats the billing fee every time, the quarterly CAQH habit that prevents a 120-day credentialing stall, the EHR line item that hides in modular pricing, and the cheapest HIPAA gap that is usually the riskiest.