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Guides for healthcareAI, quality, and outreach.

Practical guides for practice, quality, pharmacy, and billing teams: HIPAA-compliant AI, care gaps, PDC, TCM, TCPA, and the files those jobs run on.

OperationsOctober 1, 2026 · Updated October 21, 2026 · 6 min read

How to Build Your ACO Quality Report With AI

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Upload your attribution, claims and gap exports to a HIPAA-compliant AI workspace, ask for each metric, check the math, and export the report.

Value-Based CareOctober 1, 2026ACO REACH is ending. The LEAD model for 2027ACO REACH ends Dec 31, 2026. CMS's LEAD Model replaces it Jan 1, 2027 with a 10-year run, two risk options and no benchmark rebasing.
ComplianceOctober 1, 2026AEP 2027 Compliance Guide for Agencies and FMOsFor AEP 2027, the 48-hour SOA wait is gone, the TPMO disclaimer comes before benefits, and cold calls are still banned. Here is the full rule set.
ComplianceOctober 1, 2026Do Patients Have to Be Told They're Talking to AI?In several states, yes. California, Utah and Texas require AI disclosure in some patient interactions. The safe rule: disclose on every AI call and text.
OperationsOctober 1, 2026 · Updated October 21, 202625 AI Prompts for Medical Practice Managers25 copy-ready AI prompts for practice managers, grouped by job, with the ones that touch patient data flagged for BAA-covered tools only.
ComplianceOctober 1, 2026 · Updated October 21, 2026AI Vendor BAA Checklist: 12 Questions to AskBefore approving an AI tool for PHI, ask these 12 questions about BAA scope, training on your data, retention, subprocessors, breach notice and audits.
Value-Based CareOctober 1, 2026Medicare Annual Wellness Visit Billing Guide (2026)Bill G0438 for a first AWV and G0439 every 12 months after: about $174 and $138 (2026 national non-facility), with no patient cost-sharing.
Value-Based CareOctober 1, 2026Build a care gap list from an attribution fileTurn a payer attribution roster into a ranked call list: dedupe, add visits and gaps, check phones and opt-outs, then prioritize and log.
OperationsOctober 1, 2026Denial analysis with AI, from the aging reportGroup denials by payer, CARC code, provider and service, split recoverable from not, flag timely filing risk, then draft appeals for review.
ComplianceOctober 1, 2026 · Updated October 21, 2026Healthcare AI Acceptable Use Policy: Free TemplateA free healthcare AI acceptable use policy template covering approved tools, PHI rules, human review, patient disclosure and enforcement.
ComplianceOctober 1, 2026 · Updated October 21, 2026How to use AI with patient data under HIPAAYou can use ChatGPT with patient information only on a plan covered by a BAA. Here is which plans qualify and how to stay within HIPAA.
PharmacyOctober 1, 2026Med Sync Program Guide for Community PharmaciesA medication synchronization program aligns a patient's chronic refills to one monthly pickup, with a check-in call a week ahead. Here's how to run one.
PharmacyOctober 1, 2026Medicare Prescription Payment Plan, explainedThe Medicare Prescription Payment Plan spreads Part D drug costs into monthly bills from the plan. It lowers no costs. Here is how it works and what to say.
Value-Based CareOctober 1, 2026Population Health Analytics Without a Data TeamSmall practices can answer core population health questions with EHR exports, payer files and an AI workspace covered by a BAA. Here's how.
Value-Based CareOctober 1, 2026Risk Adjustment Year-End Checklist for Primary CareRisk adjustment diagnoses reset every January. In Q4, pull your recapture list, rank it, reach patients and get chronic conditions documented at a visit.
ComplianceOctober 1, 2026 · Updated October 21, 2026Shadow AI: what staff paste into ChatGPTShadow AI is staff using unapproved AI tools at work. In healthcare it puts PHI into tools with no BAA. Here is how to find it and fix it.
Value-Based CareOctober 1, 2026TCM Billing: The 2-Business-Day Rule (99495, 99496)To bill TCM, contact the patient within 2 business days of discharge and see them within 7 or 14 days, depending on complexity.
OperationsOctober 1, 2026Warm transfer vs voicemail for patient callsA warm transfer connects the patient live to the right person with context. Voicemail starts a game of phone tag. Here's how AI handoffs should work.
NewsAugust 4, 2026Massive Bio invests in RivviMassive Bio made its first strategic investment in Rivvi, pairing oncology intelligence with an agentic action layer.
OperationsJuly 30, 2025 · Updated October 1, 2026AI patient communication: what outreach really costsA staff outreach call costs your loaded hourly rate divided by completed conversations per hour. Here's the 2026 math from BLS data, and what AI changes.
TechnologyJuly 30, 2025 · Updated October 21, 2026Why not give everyone Copilot for healthcareCopilot can be HIPAA-covered, so compliance isn't the gap. Healthcare data, org memory and patient channels are. A fair build vs buy framework.
Value-Based CareJuly 30, 2025 · Updated October 1, 2026CCM vs APCM in 2026: which should you bill?Bill CCM when you can document monthly minutes on complex patients; bill APCM when you want a flat monthly code with no time tracking.
PharmacyJuly 30, 2025 · Updated October 1, 2026PDC Fail Date: How to Calculate It and When to ActA PDC fail date is the last day a patient can refill and still reach 80% for the year. Here is the math, a worked example, and when to call.
Value-Based CareJuly 30, 2025 · Updated October 1, 2026One patient, one conversation for gap outreachConsolidate care gap outreach by keeping one record per patient with every open item, then covering them in one prioritized conversation.
OperationsJuly 30, 2025 · Updated October 1, 2026Patient Outreach Without EHR IntegrationYou can run patient outreach without EHR integration: export a list, run calls and texts, transfer or task scheduling, and log outcomes.
ComplianceJuly 30, 2025 · Updated October 8, 20262027 Medicare Star Ratings: what changedCMS posted the 2027 Star Ratings on October 8, 2026. They affect 2028 quality bonus payments. Four measures are new at weight 1, three left this file, and physical and mental health now count at weight 3.
Value-Based CareJuly 30, 2025 · Updated October 1, 2026How to Analyze a Payer Care Gap Report With AIUpload the payer file to an AI tool covered by a BAA, map and dedupe it, then ask which patients to reach first. Here is the step-by-step.
PharmacyJuly 30, 2025 · Updated October 1, 2026How to improve PDC for medication adherenceImprove PDC by working the list in fail-date order, calling early, finding the real barrier, and routing clinical questions to a pharmacist.
ComplianceJuly 30, 2025 · Updated October 1, 2026TCPA Rules for Healthcare Calls and Texts (2026)The TCPA healthcare exemption waives written consent, not consent. Here are the 2026 rules for patient calls, texts, AI voices and opt-outs.

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How to Build Your ACO Quality Report With AI

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