Graft application billing has not kept pace with the CTP rule change for most wound care groups, and the gap shows up as underpayment on every claim still coded and documented the old way. CMS restructured how cellular and tissue-based products (CTPs) are paid under the CY 2026 Physician Fee Schedule Final Rule, moving most […]
The CY2026 ASC Payment Rule adds 289 procedures to the ASC Covered Procedures List through revised coverage criteria, plus 271 additional codes carried over as CMS phases out the Inpatient Only List, bringing the total number of newly ASC-eligible procedures to more than 500. What Changed in the CY2026 ASC Payment Rule? CMS finalized the […]
Yes, for most healthcare organizations, Root Cause Denial Analysis is missing, and that gap is exactly why the same denials keep resurfacing month after month. It is the practice of tracing every denied claim back to the operational or clinical breakdown that caused it, rather than reworking the claim and moving on. Most facilities treat […]
Yes, for most multi-provider practices and facilities, medical necessity denials are one of the largest, most preventable sources of revenue leakage on the books. They happen when a payer decides that the documentation submitted doesn’t justify the service billed, even when the care itself was completely appropriate. The result is a stalled claim, a frustrated […]
In-house family practice billing typically costs $66,000 to $75,000 per 12 months per biller once salary, benefits, and software are counted, but the real comparison isn’t cost alone: outsourced partners specialized in family practice typically capture Chronic Care Management, Annual Wellness Visit, and Transitional Care Management revenue that generalist in-house teams routinely leave unbilled, which […]
Yes, for a mid-size multi-site health system, reactive claim denial management can realistically cost $5 million or more a year once you add up unrecovered write-offs, rework labor, delayed cash flow, and the staff hours spent fighting the same denials over and over. Most facilities never see the full number because it’s scattered across a […]
Yes, in most cases the 2026 cataract reimbursement changes are hurting ASC margin, even when the headline number looks like an increase. The Medicare facility rate for cataract surgery (CPT 66984) rose 3.4% for 2026, but the physician payment for the same procedure fell 11%, and a separate CMS policy quietly reduced indirect practice expense […]
Yes, in most practices, refraction billing is one of the leading causes of Optometry Claim Denials, and it happens for a simple reason: CPT 92015 (refraction) is statutorily excluded from Medicare coverage, yet many practices still bill it like a routine covered service. When refraction gets bundled into a medical exam claim, sent to the […]
Yes, for most procedure-heavy orthopedic groups, the CY 2026 Medicare Physician Fee Schedule quietly reduces orthopedic reimbursement even though the headline conversion factor went up. CMS finalized a 3.26% to 3.77% increase to the conversion factor for 2026, but it paired that increase with a −2.5% “efficiency adjustment” applied to work RVUs on nearly every […]
No, your skin substitute billing is likely not compliant if you are still coding and pricing products under the old per-product ASP methodology. Effective January 1, 2026, CMS replaced individual product-based payment with a single flat national rate of $127.14 per square centimeter for most skin substitutes used in physician offices and hospital outpatient departments. […]
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