RxRev guides
Make a clearer decision before you hand off the work.
Use these practical guides to define a denial queue, organize provider enrollment, choose an aging A/R project, or map a prior-authorization backlog.
How to define a denial queue before asking for outside help
Choose the claims, allowed actions, escalation contacts, and finish line before another team starts work.
Read the guide →CredentialingA credentialing checklist for a new provider
Organize the provider, payer, documents, approvals, and status updates before applications begin.
Read the guide →A/R operationsHow to start with one focused aging A/R project
Test added help on a defined group of older accounts without moving your entire billing operation.
Read the guide →Patient accessHow to map a prior-authorization request from start to finish
Identify the requirement, document owner, payer follow-up, and clinical escalation before the request stalls.
Read the guide →Coding editsWhich NCCI Edit Files Took Effect October 1, 2026? PTP v323r0 and the Q4 MUE Tables
CMS's Q4 2026 NCCI files: Practitioner and Hospital PTP edits v323r0 and the Q4 MUE tables, effective Oct 1, 2026. What PTP edits and MUEs are, in CMS's words.
Read the guide →ClaimsWhat Is the Medicare Timely Filing Limit? 1 Calendar Year From the Date of Service
CMS: file Medicare claims no later than 1 calendar year after the date of service, and you can't appeal a determination that a claim wasn't filed on time. Here's the rule in CMS's words.
Read the guide →ClaimsClerical Error on a Medicare Claim: Reopening or Appeal? What 42 CFR 405.980 Says
Under 42 CFR 405.980, contractors must process clerical errors as reopenings, not redeterminations. The regulation's examples, the request windows, and the separate-clocks rule.
Read the guide →EnrollmentMoved, Added, or Closed a Practice Location? Medicare's Reporting Clock Is 30 Days
42 CFR 424.516(d): physicians, NPPs, and their organizations must report a change, addition, or deletion of a practice location to their Medicare contractor within 30 days.
Read the guide →Patient accessShould You Ask About Other Insurance at Every Medicare Visit? What CMS's MSP Booklet Says
CMS (MLN006903, July 2025): ask patients about other coverage that could be primary to Medicare at each visit before providing services, and check eligibility. The MSP rules in CMS's words.
Read the guide →HIPAAHow Long Do You Have to Respond to a Patient's Records Request? HIPAA's 30-Day Rule (45 CFR 164.524)
45 CFR 164.524: act on a patient's request for access no later than 30 days after receipt, with one extension of no more than 30 days. The extension rules and fee limits in the regulation's words.
Read the guide →CredentialingHow Often Do You Attest Your Provider Data Portal Profile? At Least Every 120 Days
Per the provider data portal operator's FAQ, providers must attest to their data profiles every 120 days (every 180 days for IL providers), or every 90 days if they act on the quarterly email. Miss the window and the status changes to Expired.
Read the guide →EnrollmentWhat Does Medicare Need for the Ordering or Certifying Provider on a Claim? A Valid NPI and the Name as It Appears in PECOS
CMS (MLN9658742, Dec 2025): the claim must have a valid NPI and the eligible provider's name as it appears in PECOS. Who can order or certify, Type 1 NPIs only, and the CMS-855O order-only enrollment, in CMS's words.
Read the guide →DocumentationIf an AI Scribe Drafts the Note, Does the Provider Still Have to Sign It? Yes, per CMS
CMS (MLN905364, July 2025): if you use a scribe, including artificial intelligence technology, sign the entry. What CMS says about scribe documentation, stamped signatures, attestation statements, the 20-day window and signature logs.
Read the guide →ClaimsHow Do You Bill a Flu Shot to Medicare? The Vaccine and the Administration Are Separate Lines
CMS lists G0008 as "Administration of influenza virus vaccine," and says Part B deductibles and coinsurance don't apply for flu vaccine products or their administration. Roster billing and the office-visit question, in the sources' own words.
Read the guide →Prior authorizationHow Fast Do Payers Have to Decide Prior Authorization Requests? 72 Hours Expedited, 7 Days Standard (CMS-0057-F)
CMS's Interoperability and Prior Authorization final rule (CMS-0057-F) requires impacted payers to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests. Who it covers, in CMS's words.
Read the guide →ClaimsHow Often Can You Bill an Annual Wellness Visit (G0438 or G0439)? Once in a 12-Month Period
CMS: you can only bill G0438 or G0439 once in a 12-month period, and not within 12 months of billing G0402 (IPPE) for the same patient. First vs subsequent AWV codes and the modifier 25 rule, in CMS's words.
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