The Revenue Cycle Management trends defining healthcare finance right now come down to one number: $28.83 billion. That is the amount CMS reported in improper Medicare Fee-for-Service payments for fiscal year 2025, and it is the clearest signal yet that the old way of running a billing department will not protect margins going forward. For […]
ASC denial management is becoming an EBITDA protection strategy because every preventable denial erodes net realized revenue at the exact margin line that determines valuation multiples, physician distributions, and lender covenant compliance. HFMA considers 5 to 10% the acceptable denial rate benchmark for healthcare organizations broadly, while well-run ASCs are expected to hold denial rates […]
Yes, your GI Billing Process should already be under review for CPT 2027. The AMA has approved significant CPT changes taking effect January 1, 2027, including new Category I reporting for endoscopic submucosal dissection in the upper and lower GI tract. The final CPT 2027 code set is still moving through its publication cycle, so […]
Appeals vs Resubmissions comes down to one question: was the claim denied because of a payer judgment call, or because of a fixable error on the claim itself? Resubmission is the right move when a claim was rejected for a correctable mistake: a typo, a missing modifier, an outdated NPI. An appeal is the right […]
AI vs Human Medical Coders isn’t a contest with one winner. AI wins on speed and consistency for high-volume, low-complexity claims. Human coders win on judgment for complex, high-dollar, and audit-sensitive cases. The groups seeing the best financial results in 2026 aren’t choosing one over the other — they’re building a coding model that routes […]
For most multi-provider OBGYN groups collecting $1 million or more per month, OBGYN underpayments cost between 2 and 4 percent of collected revenue across the first half of 2026, and almost none of it shows up on a standard denial report. Underpayments are not denials. They are claims paid, posted, and closed out below the […]
AI in Revenue Cycle Management is not a magic fix that replaces your billing team overnight — it is a governed, data-driven layer that predicts denials, automates prior authorizations, and protects margins when it is implemented correctly. That single distinction separates the organizations seeing real returns from the ones stuck paying for software nobody trusts. […]
Cardiology Billing Services are only as good as the numbers behind them, and measuring performance starts with a small set of metrics that tell you exactly where revenue is being protected or lost. The direct answer: track clean claim rate, denial rate, days in AR, and net collection rate every month, and compare each against […]
Medicare Advantage denials are the single largest driver of legacy AR in internal medicine because MA plans deny roughly 17% of submitted claims, more than double traditional Medicare’s 8%, and apply prior authorization to internal medicine services at rates 37% higher than in 2022. For a $4 million group, that gap represents roughly $680,000 in […]
The direct answer: rising Gastroenterology AR is almost never a volume problem. It is a coding, denial, and follow-up problem that compounds month over month until old AR recovery becomes a full-time project instead of a routine task. Gastroenterology AR grows even when patient volume is strong because the revenue leak usually happens after the […]
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