MA Plans Applied Prior Auth to Internal Medicine Services at Rates 37% Higher Than 2022

Yes — Medicare Advantage plans applied prior authorization requirements to internal medicine services at rates 37% higher than 2022, driven by expanded PA requirement lists, AI-assisted claim adjudication, and tighter chronic care and diagnostic service scrutiny that has fundamentally altered revenue predictability for high-volume primary care practices. For internal medicine groups operating on thin per-encounter […]

Why Are Orthopedic Billing Denials Getting Worse in the Second Half of 2026?

Orthopedic billing denials are rising in the second half of 2026 mainly because of three converging forces: the CY 2026 Medicare Physician Fee Schedule’s efficiency adjustment and practice expense cuts, sharper OIG scrutiny of modifier 25 use, and expanding prior-authorization requirements for implant-heavy and device-based procedures. Practices that haven’t updated their coding and documentation workflows […]

Are Global Maternity Code Denials Climbing Despite the 2026 RVU Exemption?

Yes — global maternity code denials are climbing in 2026 despite the CMS RVU exemption, because the fee schedule protection preserves the allowable rate but does nothing to prevent payer-level claim edits targeting antepartum visit documentation, co-management modifier usage, and VBAC medical necessity narratives. The 2026 CMS Physician Fee Schedule preserved OBGYN global maternity codes […]

How Do You Fix Wound Care Billing Problems Before They Cost You Q3 Revenue?

Wound care billing problems cost the average wound care practice between $80,000 and $200,000 per year in denied claims, undercaptured supply charges, and documentation-driven write-offs. The fix starts before Q3 — with a real-time audit of your coding accuracy, LCD compliance, and payer-specific denial patterns. Here is exactly how to do it. Why Wound Care […]

Why Primary Care Practices Can’t Afford Reactive Denial Management in 2026 — And What Works Instead

Primary care practices can’t afford reactive denial management in 2026 because the cost of a denied claim has tripled — MA plan prior authorization complexity, CCM documentation requirements, and E/M coding scrutiny mean that working a denial now requires three to five times the staff labor it required in 2022, while the 2026 MPFS conversion […]

Why ASC Claim Denial Rates Are Climbing in 2026 — And How to Fix the Root Cause Before Q3

ASC claim denial rates are climbing in 2026 because prior authorization policy changes, revised NCCI bundling edits, and implant documentation requirements tightened simultaneously — and most ambulatory surgical center billing workflows were not updated to match, creating a compounding denial backlog that will reach maximum AR aging damage by Q3 if root causes are not […]

How Are the 2026 Medicare RVU Adjustments Reducing Neurology Reimbursement?

How the 2026 Medicare RVU Adjustments Are Reducing Neurology Reimbursement Per Encounter

The 2026 Medicare Physician Fee Schedule (MPFS) RVU adjustments are directly reducing per-encounter neurology reimbursement — with the budget-neutrality conversion factor cut translating to $8 to $22 in lost revenue per high-complexity office visit and compounding into $90,000 to $240,000 in per-physician annual shortfall for practices that have not restructured their Revenue Cycle Management (RCM) […]

Why Is Your Orthopedic Billing Company Not Closing AR Gaps at Mid-Year?

If your orthopedic billing company is not actively identifying and closing accounts receivable (AR) gaps at mid-year, you are most likely sitting on tens of thousands of dollars in stalled or written-off revenue. The direct answer: most orthopedic billing companies are reactive, not proactive. They process claims but do not engineer the recovery infrastructure needed […]

How Do You Know If Your Wound Care Revenue Cycle Is Losing Money at Mid-Year?

If patient volume is steady but collections feel flat, your wound care revenue cycle is likely losing money right now — and mid-year is exactly when most practices find out. The gap between what your clinicians bill and what actually gets collected rarely comes from a single broken process. It builds quietly: one denied CTP […]

Mid-Year Billing Cleanup: What Needs to Be Fixed Before Q3?

A Mid-Year Billing Cleanup is a structured audit of your revenue cycle performed at the halfway point of the year to fix claim errors, reconcile unapplied payments, and stop revenue leakage before Q3 makes it worse. For physician groups and specialty practices, completing this review in June — not December — is what separates practices […]

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