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Medical Health Care Solutions

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Medical Health Care Solutions

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Medical Healthcare Solutions, Inc. (MHS) provides complete billing and practice management services for Healthcare Professionals.

Solutions for all your medical billing needs. MHS strives for excellence in customer service and satisfaction. We will work with our clients to ensure that all of their billing needs are met. MHS integrates the latest technology and the expertise of our staff to provide the best solution to your billing needs. Longevity of clients in the service industry confirms the strength of the service being provided. MHS can boast that the majority of providers who were using our service at the time of inception in 1991, still remain a client today! Our providers are happy to speak with prospective clients to share their experiences with MHS. We continually monitor the market for the very best tools available to provide the most efficient services to our providers. As you explore our web site, you will note that MHS is at the cutting edge of technology advancements, allowing us to provide the very best of service to our clients. MHS employs over 150 personnel to service the billing requirements of our providers. We guarantee to provide the most efficient, effective and professional service possible.

10/31/2026

Happy Halloween from our team at Medical Healthcare Solutions, Inc. (MHS)! We hope your night is full of treats and your AR stays free of tricks. Stay safe out there. 🎃

10/29/2026

⏱️ Prior auth is changing. Some changes are federal rules. Others are promises health plans made on their own.

CMS requirements (CMS-0057-F):
▪️ Since 2026, Medicare Advantage, Medicaid and other covered plans must decide urgent requests within 72 hours and standard ones within 7 calendar days
▪️ By January 1, 2027, those plans must offer electronic prior auth connections (APIs)

Voluntary health plan commitments (AHIP pledge):
▪️ Participating plans pledged to honor an existing auth for a 90-day transition when a patient switches to their plan
▪️ Participating plans pledged that in 2027, at least 80% of complete electronic prior auth approvals get a real-time answer

These pledges are not federal law, and not every plan signed on. Commercial rules vary by plan, state and product. For example, UnitedHealthcare's commercial prior auth list (effective Sept. 1, 2026) includes total hip and knee replacement codes and adds site-of-service review for many arthroscopy codes in most states.

Open enrollment is now, so every January surgery needs a fresh eligibility and auth check.

Medical Healthcare Solutions, Inc. (MHS) runs auths and eligibility for ortho practices and surgery centers every day.

Learn more: https://medicalhealthcaresolutions.com/solutions/ambulatory-surgery-center-billing/

Source: CMS-0057-F, AHIP, UnitedHealthcare Commercial PA Requirements (Sept. 2026)

10/28/2026

Proud to support Endicott Men's Ice Hockey! 🏒

Medical Healthcare Solutions, Inc. (MHS) is excited to be on the boards at the Gulls' home rink, right under some serious hardware: Conference Champions, NCAA Quarterfinals, and a 2023 Final Four run.

Good luck this season, Gulls! 💙💚

Endicott College Endicott College Athletics and Recreation

10/27/2026

📉 Congress gave doctors a one-time 2.5% Medicare raise for 2026. It runs out December 31.

Under the 2027 proposal, the conversion factor drops from $33.40 to $32.84 for most physicians. That is about 1.7% lower. CMS's 2026 "efficiency adjustment," which trimmed work values on most surgical codes, also stays in place.

Here is the part many ortho groups miss. A lot of commercial contracts pay a percent of Medicare, like 120% of the current fee schedule. When Medicare drops, those contracts can drop with it, often with no notice.

Before January:
✅ List every contract tied to Medicare rates
✅ Check whether it uses the current year or a locked year
✅ Model 2027 revenue for your top 20 codes by payer
✅ Start talks with payers now, not after the first short check

Medical Healthcare Solutions, Inc. (MHS) can run this model for your practice as part of a free revenue analysis.

Get Pricing & Analysis: https://medicalhealthcaresolutions.com/free-revenue-analysis/

Source: CMS 2027 PFS proposed rule

10/22/2026

🗓️ Two code updates in one quarter. Both can stop clean claims cold.

▪️ October 1, 2026: the FY 2027 ICD-10-CM diagnosis codes took effect. Claims with retired or incomplete codes start bouncing right away.
▪️ January 1, 2027: the AMA's CPT 2027 code set takes effect. It has 299 new codes, 74 revised codes and 80 deleted codes.

Deleted codes are the quiet danger. A code that worked on December 31 can deny on January 2.

A simple year-end code check for ortho practices and ASCs:
1️⃣ Update EHR pick lists, superbills and favorites
2️⃣ Update the ASC charge master and fee schedules
3️⃣ Find any scheduled January cases that use deleted codes
4️⃣ Watch the first two weeks of January remits closely

Payers do not always load new codes on day one either. Watch for "invalid code" denials on correct claims and appeal them fast.

The certified coders at Medical Healthcare Solutions, Inc. (MHS) run this check for every client before each code update.

Learn more: https://medicalhealthcaresolutions.com/orthopedic-asc-coding-optimization/

Source: CMS, AMA

10/20/2026

⚠️ For years, Original Medicare rarely needed prior authorization. In six states, that changed this year.

CMS's WISeR model started in January in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Outside companies, using AI plus human review, now check certain services before they are paid. The list includes:

▪️ Cervical fusion
▪️ Epidural steroid injections
▪️ Knee arthroscopy (lavage and debridement) for arthritis
▪️ Vertebral augmentation for compression fractures

Practices can request prior auth or face a pre-payment review. Doctors in Arizona have said the early months brought a wave of denials and weeks of delay.

The model runs through 2031. Even if your practice is not in those states, this shows where Medicare is going.

What helps right now: documentation that hits the coverage rules (LCDs and NCDs) on the first try, and a team that tracks every request to the finish.

Medical Healthcare Solutions, Inc. (MHS) handles prior auth and denial follow-up for ortho and spine practices.

Learn more: https://medicalhealthcaresolutions.com/orthopedic-medical-billing-services/

Source: CMS WISeR model guide, KJZZ

10/15/2026

📋 More ortho cases than ever can now be done in a surgery center.

In January, CMS added 168 orthopedic codes to the ASC covered procedures list. That includes hip hemiarthroplasty, conversion to total hip, hip revisions, and shoulder revisions. For 2027, CMS has proposed adding 618 more codes.

Medicare saying yes is only step one. Getting paid is a different job:
✅ Commercial payers do not follow Medicare automatically. Many contracts need an amendment to cover new codes.
✅ New complex cases often mean high-cost implants. Know which contracts carve them out.
✅ Prior auth and site-of-service rules change when a case moves out of the hospital.
✅ Your fee schedule and charge master need the new codes before the first case.

Centers that skip these steps do the harder case and get paid like it never happened.

Medical Healthcare Solutions, Inc. (MHS) helps ASCs get the contracts and coding ready before the new cases hit the schedule.

Learn more: https://medicalhealthcaresolutions.com/orthopedic-asc-coding-optimization/

Source: CMS, Becker's ASC

10/13/2026

💉 Knee pain visit plus a 20610 injection, same day. Ortho clinics bill that every hour.

For 2027, CMS proposes a change to how these days are paid. It is a proposal, not current policy.

Under the proposal, when a separately payable E/M visit is billed with modifier 25 on the same day as a procedure with a 0, 10 or 90-day global, the higher-paid service would be paid at 100%. The other service would be paid at 50%. CMS also asked whether 25% would be a better number than 50%.

That could reach a lot of ortho: joint injections, trigger point injections and minor procedures done in clinic.

One thing does not change. Modifier 25 does not make a visit payable by itself. The E/M has to be significant and separately identifiable from the procedure, and the notes have to meet the documentation rules. And when the visit is where the decision for a major surgery is made, modifier 57 may apply instead of 25.

Before the final rule lands:
1️⃣ Pull how often your providers bill a -25 visit with a procedure
2️⃣ Put a dollar figure on it at 50% and at 25%
3️⃣ Check that each -25 visit is documented as a significant, separate service
4️⃣ Make sure decision-for-surgery visits use the right modifier

Medical Healthcare Solutions, Inc. (MHS) audits modifier 25 use for our ortho clients every month.

Learn more: https://medicalhealthcaresolutions.com/orthopedic-medical-billing-services/

Source: CMS 2027 PFS proposed rule

10/08/2026

🏥 CMS proposed a 2.4% average raise for surgery centers in 2027. Read past the headline.

The Ambulatory Surgery Center Association says 85 of the 100 most common ASC procedures could still be paid less. A major factor is CMS's proposed ASC weight scalar, which reduces the relative weights used to calculate many ASC payments.

Ortho is one of the bright spots. In CMS's ASC rate files, the national ASC rate for a total knee (27447) goes from $9,393 in 2026 to a proposed $9,787 in 2027. That is before the local wage adjustment. Meanwhile the surgeon's fee for that same knee is proposed to drop about 20%.

So the facility and the surgeon could move in opposite directions on the same case.

What ASC leaders should do before January:
✅ Run your own top 25 procedures through the 2027 rates
✅ Do not budget off the 2.4% average
✅ Check commercial contracts that pay a percent of the Medicare ASC rate

Medical Healthcare Solutions, Inc. (MHS) has billed for ASCs for 20 years. We read these rules so your team does not have to.

Learn more: https://medicalhealthcaresolutions.com/solutions/ambulatory-surgery-center-billing/

Source: CMS 2027 OPPS/ASC proposed rule and ASC Addendum AA, ASCA

10/06/2026

🦴 CMS has proposed the biggest cut to joint replacement surgeon pay in decades.

In the 2027 Physician Fee Schedule proposal, total knee (27447) and total hip (27130) lose about 20% of their value. The national surgeon payment for a total knee would fall from about $1,159 to about $922. Total shoulder and shoulder hemiarthroplasty are in the same cut.

This comes on top of the 2026 cuts, when total hip and knee already lost about 7.5%.

The AAOS president called these "the most we have seen in 30 years." Comments closed September 14, and the final rule is expected in early November.

What smart ortho groups are doing now:
▪️ Modeling 2027 Medicare revenue by CPT code, not by average
▪️ Checking which commercial contracts pay a percent of Medicare
▪️ Tightening every other line of revenue before January

Medical Healthcare Solutions, Inc. (MHS) is tracking this rule for our ortho clients line by line.

Learn more: https://medicalhealthcaresolutions.com/orthopedic-medical-billing-services/

Source: CMS 2027 PFS proposed rule, AAHKS

Address

300 Brickstone Square
Andover, MA
01810

Opening Hours

Monday	8am - 5pm
Tuesday	8am - 5pm
Wednesday	8am - 5pm
Thursday	8am - 5pm
Friday	8am - 5pm

Website

http://www.medicalhealthcaresolutions.com/

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