QualCode, Inc.

QualCode, Inc. A reliable and results driven Revenue Cycle Management vendor specializing in revenue integrity and compliance for over 25 years!

🆕QualCode, Inc. is now an approved supplier with Kaiser Permanente.For 25 years, we have focused on protecting revenue a...
01/07/2026

🆕QualCode, Inc. is now an approved supplier with Kaiser Permanente.

For 25 years, we have focused on protecting revenue and reducing risk in the most complex areas of healthcare reimbursement—particularly DRG and clinical validation, coding quality, and audit-grade revenue integrity.
We look forward to supporting the Kaiser Permanente ecosystem as needs arise.

Natalie Williams
President & CEO, QualCode, Inc.

01/07/2026

✨💻✨ At QualCode, we are focused on helping you bridge the gap between complex new documentation requirements and sustainable revenue integrity. Let’s make 2026 a year of accuracy and financial strength.

01/05/2026

🚨 Major Healthcare Policies Take Effect in 2026
As we kick off 2026, several federal and state healthcare policies are set to reshape provider operations, reimbursement, insurance markets, and patient access.
Becker’s Hospital Review

🔹 Expiration of ACA enhanced subsidies — millions could face higher premiums without extended tax credits.

🔹 CMS expands site-neutral payments and tightens prior authorization rules — expect shifts in how services are reimbursed and approved.

🔹 Medicare drug pricing negotiations and state coverage mandates — new cost and coverage rules are coming into play in select markets.

These changes make billing accuracy, documentation readiness, and payer strategy more critical than ever.
🛠️ At QualCode, we help teams translate policy change into compliance action and revenue protection. DM us to get your 2026 RCM readiness check.

12/18/2025

🚨 ICD-10 Code Update Alert — CMS Just Posted New Files for 2026!

Includes a special April 1, 2026 update effective through September. These files include the latest diagnosis and procedure codes every coder, biller, and RCM leader should have loaded into their workflows.

⚙️ Why this matters:
✔ Accurate claims depend on the right ICD-10 diagnosis and procedure codes.

✔ Using outdated codes increases the risk of denials and audit flags.

✔ Some codes impact DRG assignment, severity adjustments, and reimbursement.

📁 Make sure your ICD-10 code tables, EHR, and CCI/NCCI edits are updated with the CMS files now available — including CM, PCS, and POA indicators.

Source: https://www.cms.gov/medicare/coding-billing/icd-10-codes

⚠️ CMS Alert for Billers & ProvidersThe latest guidance from CMS under NCA 320 makes clear: Medicare will not cover item...
12/08/2025

⚠️ CMS Alert for Billers & Providers
The latest guidance from CMS under NCA 320 makes clear: Medicare will not cover items or services that are deemed medically unnecessary, fall outside defined benefit categories, or lack “reasonable and necessary” justification.

That means any billed service must:
• meet a valid medical-need justification,
• fall under a recognized Medicare benefit category, and
• comply with any applicable National or Local Coverage Determinations.

At QualCode, we help you audit your Medicare billing practices — ensuring claims are backed by proper documentation, coverage criteria, and compliance standards to minimize denials and audit risk.

https://www.cms.gov/medicare-coverage-database/view/nca.aspx?NCAId=320

Address

418 Broadway Street, North
Albany, NY
12207

Opening Hours

Monday 8:30am - 5pm
Tuesday 8:30am - 5pm
Wednesday 8:30am - 5pm
Thursday 8:30am - 5pm
Friday 8:30am - 5pm

Telephone

+12123686200

Website

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