Would Primary Care E/M Coding Patterns Survive a UPIC or RAC Audit Today?

Primary Care E/M Coding patterns at most practices would not survive a UPIC or RAC Audit today — CPT 99214, the most-billed Medicare Part B code nationally, generated $459 million in improper payments in the CMS 2025 Medicare FFS Supplemental Improper Payment Data review, with 63% of those errors from incorrect coding and the remainder […]

Is Your Clean Claim Rate Lying to You — Here’s the Metric That Actually Matters

Your Clean Claim Rate is lying to you — because a claim accepted by the payer is not the same as a claim paid in full, and multi-site groups relying on this single metric are bleeding margin they cannot see on any dashboard. This is the most expensive blind spot in enterprise revenue cycle management […]

When to Switch Optometry Billing Partners — The 2026 Decision Framework

You should switch optometry billing partners when your Net Collection Ratio falls below 93%, Days in AR exceed 35 days, or your current vendor has not updated billing protocols for the CY 2026 MPFS Final Rule, new CPT codes, and the FY 2026 ICD-10 changes — because each of these gaps is silently compounding revenue […]

Are SNF Managed Care Contracts Paying What They Owe — or Quietly Eroding Margins?

SNF managed care contracts are quietly eroding margins at most skilled nursing facilities through four simultaneous payment failures: Medicare Advantage plans underpaying against contracted per diem rates without detection, prior authorization denials on stays that qualify under traditional Medicare standards, PDPM ICD-10 mapping errors that misclassify residents into lower-paying clinical categories, and SNF VBP Program […]

How to Evaluate a Wound Care Billing Company Before the Q2 Denial Surge

To evaluate a wound care billing company before Q2, you must assess whether they have restructured their workflows, documentation infrastructure, and coding protocols around the 2026 CMS regulatory reset — because a generalist billing partner operating on 2024 logic is actively converting your April and May claims into unrecoverable write-offs. Q2 is not an arbitrary […]

Are Denials Structurally Built Into Your Family Practice Billing Process?

Family Practice Billing Process denials are not random claim errors — they are structural failures embedded in the workflow itself: Modifier 25 applied incorrectly on same-day preventive and problem visits, G2211 complexity add-on billed in conflict with Modifier 25 under 2026 CMS rules, chronic care management codes undercaptured or missing documentation, and prior authorization gaps […]

Facet Injection Billing: Why Joint Count Errors Are the #1 Audit Flag?

Joint count errors are the #1 audit flag in facet injection billing because CMS requires billing by the number of facet joints injected — not the number of nerves blocked — and high-volume interventional pain groups routinely misapply this distinction at scale, triggering Targeted Probe and Educate reviews that cost multi-provider practices an average of […]

What Is Causing Neurology Claim Denials — and How Do You Fix Them Permanently?

Neurology claim denials are caused by five structural billing failures that compound across every claim cycle: documentation insufficient to support medical necessity, incorrect modifier application on EEG and EMG procedures, ICD-10 specificity gaps following the October 2025 deletion of G35 for multiple sclerosis, prior authorization failures on high-cost diagnostic studies, and NCCI bundling violations on […]

Denial Prevention in Pain Management: The 3 Gaps Costing Groups Most

Denial prevention in pain management is the proactive, infrastructure-level discipline of eliminating clinical, administrative, and coding root causes of claim rejection before submission — and for multi-provider groups in 2026, federal enforcement data makes the cost of the three gaps below impossible to ignore. The OIG’s active seven-project audit series on spinal pain management services […]

Wrong Anesthesia Modifier = 30% Revenue Loss: Is Your Group at Risk?

Yes — a wrong anesthesia modifier can directly trigger 30% or greater revenue loss for your group through immediate claim denials, medical direction downcodes, and retroactive payer clawbacks on cases already closed. For multi-provider anesthesia groups and hospital-based practices operating in 2026, modifier precision is not a billing department concern — it is a CFO-level […]

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