The Practice Layer

This week on the Practice Layer, BCBS Michigan cuts modifier 25 payments in half, CMS finally comes for MA overpayments, and the 4 upstream metrics that actually predict your cash flow.

This week on the Practice Layer, The OIG reviewed modifier 25 claims and found 90% compliance. Sounds like a win. It's not. We break down what $62.9M in errors means for your practice, why BCBSM is cutting reimbursement 50%, and the self-audit you should run today.

This week on the Practice Layer, we're unpacking the biggest reimbursement story in dermatology: skin substitute payments just collapsed from $2,000 to $127 per square centimeter. Plus, prior auth reform is picking up steam in Missouri and beyond, False Claims settlements hit a record $6.8 billion, and why basic automation is outperforming generative AI.

This week on The Practice Layer: prior auth reforms, a $556M Medicare fraud settlement, and why half of New Yorkers can't afford a $1K bill. Plus: the growth math most practices get wrong.

This week on the Practice Layer, we look at why January insurance payments often drop to zero and how deductibles quietly shift more revenue responsibility to patients.