#healthcare
Financial management and accounting solutions for healthcare businesses
As of January 1, 2026, CMS-0057-F requires Medicare Advantage, Medicaid, CHIP, and ACA marketplace payers to decide prior authorization requests within 72 hours (expedited) or 7 calendar days (standard) and to give specific denial reasons — with FHIR-based prior auth APIs mandated by January 1, 2027. Here's what small medical and dental practices should do now.
Home care agencies collect from private pay, Medicaid MCOs, and VA Aid and Attendance on three different timelines while caregiver payroll runs on a fixed biweekly schedule, so tracking AR by payer separately (not blended) is the key to forecasting cash and catching the 2026 EVV hard-edit denials that make unresolved visit exceptions permanently unbillable.
Med spas that book prepaid packages, gift cards, and membership fees as revenue at the point of sale overstate income and understate the deferred-revenue liability they owe clients — with the U.S. med spa industry at roughly $21.4 billion in 2026 and package sales now about 29% of client spending, the resulting distortion can turn a strong bank balance into an unexplained cash crunch two months later.
The CFPB's nationwide medical debt credit reporting ban was vacated by a Texas federal court in July 2025, leaving protection to 15 state laws and the bureaus' voluntary policies — paid debts, collections under $500, and a 365-day grace period stay off reports everywhere. Here's what still applies in your state and how to keep a medical collection from raising your business loan rate.
ABA practices bill in 15-minute units under CPT codes 97153 and 97155, face industry-wide denial rates of 15-30%, and see predictable cash-flow dips when six-month prior authorizations lapse before renewal paperwork clears.
A 2.5% CMS cut to OT evaluation codes, a $2,480 KX modifier threshold, and the 8-minute rule all shape 2026 revenue for occupational therapy private practices, and each one requires a specific change to how the books are kept.
Medicare excludes routine foot care under Section 1862(a)(13) unless a Q7, Q8, or Q9 modifier documents a qualifying systemic condition, and a missed modifier produces a flat claim denial that podiatry practices often never trace back to a root cause in their books.
AI receptionist platforms cost $99–$299 a month versus $2,800–$4,500 for a fully-loaded human hire, but complex complaints, emotional calls, and HIPAA-covered patient information still require human judgment or a signed Business Associate Agreement — here's the real cost and capability comparison for 2026.
How translation agencies and medical transcription services can cost freelance linguist payables against per-word client billing, avoid 1099 vs. W-2 misclassification risk, and meet HIPAA business associate recordkeeping requirements.
A virtual medical scribe agency needs a signed Business Associate Agreement before billing a single shift, and its pricing model — hourly, monthly subscription, or per-encounter — determines when revenue should be recognized and how the chart of accounts should be structured.
Washington employers must withhold 0.58% of gross wages with no cap for the WA Cares Fund, the state's employee-funded long-term care program that began paying benefits up to $36,500 per worker in July 2026, and file combined quarterly reports with the Employment Security Department.
Locum tenens and travel-healthcare clinicians are 1099 contractors who owe 15.3% self-employment tax, must establish a valid IRS tax home to deduct travel costs, and often file non-resident state returns for every state where they worked.
