Your PDGM reimbursement fell because CMS’s CY 2026 recalibration redistributes payment value across all 432 case-mix groups in a budget-neutral way — a margin event that shows up on your P&L before it ever shows up in a coding audit. PDGM Reimbursement Decline: A Margin Problem, Not a Documentation Problem For a CFO reviewing a […]
Yes, Optometry Denial Management can meaningfully reduce timely filing losses, but only when it is built around root cause data rather than faster resubmission. Most optometry groups treat a timely filing denial as a speed problem and try to refile quicker. The actual problem sits upstream, in the workflow gaps that delay a claim long […]
If your wound care practice sits in the $100K to $150K monthly insurance collection range, you’re at exactly the size where unworked denials do the most damage and get noticed the least. You’re large enough that no single person can track every claim by hand, but not yet large enough to have a dedicated team […]
If your net collection ratio (NCR) is under 95%, then yes, you are below the 2026 benchmark, and the gap is costing you real money. The commonly cited MGMA-aligned target is 95% or higher, and top-performing groups reach 96% to 99%. Strong Optometry Billing Services close that gap by getting three things right: the medical-versus-vision […]
Effective Family Practice denial management doesn’t depend on the denial rate — it depends on what happens after. A Family Practice group can sit inside HFMA’s 5–10% “acceptable” denial rate range and still lose significant revenue every month. A denial your team doesn’t work in time doesn’t stay open. Once the payer’s filing deadline passes, […]
Yes, optometry RCM services can improve NCR within 90 days, but only when the approach is built for optometry’s specific billing structure and not adapted from generic medical billing. Optometry practices routinely see Net Collection Ratio stuck in the 80 to 85% range, not because of poor front-desk performance, but because vision plan billing, medical […]
Yes, if your group is only tracking denial rate and not tracking what happens to those claims afterward. A multi-provider wound care group can post a completely normal denial rate and still be sitting on $100K to $250K a year in denied claims that were technically recoverable but never got worked to resolution before the […]
Medicare Advantage denials for skilled nursing facility stays are rising. The main driver: 99% of MA enrollees now sit in plans that require prior authorization for SNF admission. A June 2026 HHS OIG report found that MA organizations denied 12% of those requests overall, and that rate reached 40% for long-stay nursing home residents. Even […]
Most primary care groups forget the reimbursement tied to Transitional Care Management Codes CPT 99495 and 99496 because Transitional Care Management runs on a strict post-discharge clock, and the required patient contact window closes before front-desk staff even see the hospital discharge summary. What Actually Qualifies as Billable Transitional Care Management Codes Transitional Care Management […]
General surgery billing services close global period documentation gaps by verifying that every post-operative encounter is coded with the correct CPT modifier, tied to the original procedure’s 90-day or 10-day window, and supported by documentation that separates related care from unrelated, reimbursable services. Left unmanaged, this gap does not show up as an obvious problem […]
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