Ophthalmology billing is complex because it runs on two coding systems at once (Eye codes and E/M codes), stacks a 92-day global surgical period on top of one of Medicare’s highest-volume procedures, and demands drug-level accuracy for injectable medications that cost more per dose than a typical office visit. A federal watchdog just flagged $124 […]
Probably not, and that’s normal. Most orthopedic groups and multi-surgeon facilities carry a meaningful chunk of orthopedic AR sitting past 90 and 120 days heading into Q4, largely because joint and spine procedures carry 90-day global billing periods, implant documentation delays, and workers’ comp cases that age slower than routine claims. The real question isn’t […]
G0511 was replaced by two paths: RHCs and FQHCs now either bill individual CPT and HCPCS care management codes per service, or bill the three-tier Advanced Primary Care Management (APCM) codes — G0556, G0557, and G0558 — introduced for CY2025 and expanded further under CY2026 rules. What Was G0511, and Why Did CMS Retire It […]
Yes. For most multi-provider practices and facilities, denial write-offs are one of the largest hidden drains on EBITDA, often erasing 3% to 5% of net patient revenue every year. Unlike a denied claim that gets reworked and paid, a write-off is money your facility has permanently given up, and it rarely shows up as a […]
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 […]
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