The ACA subsidy expiry — the December 31, 2025 lapse of enhanced premium tax credits introduced under the American Rescue Plan Act and extended through the Inflation Reduction Act — means that primary care practices will absorb a direct, measurable shift in their primary care RCM risk profile: 4.8 million more Americans are projected to […]
Your Optometry RCM is built for the wrong revenue model if it processes VSP and EyeMed claims smoothly but collapses when a patient presents with diabetic retinopathy, glaucoma, or macular degeneration — and that gap is costing multi-provider eye care groups $200,000 or more annually in misclassified encounters. The shift is no longer gradual. As […]
ASC margins are shrinking in 2026 despite record case volume because costs are rising faster than reimbursement across four simultaneous pressure points: anesthesia stipend requirements now affecting 44% of ASCs, medical supply chain costs projected to increase 2.41%, a CMS payment update of only 2.6% against a 3.3% market basket — and prior authorization requirements […]
Accounts receivable management is the biggest hidden risk in primary care billing — and most practices do not realize the damage until it manifests as a cash flow crisis. While claim submission rates and denial percentages capture leadership attention, the slow aging of AR buckets operates in the background, compressing working capital, distorting financial performance, […]
Prior auth denials for total joint arthroplasty are no longer an administrative nuisance — they are a structural margin threat that multi-surgeon orthopedic groups must address at the revenue operations level, not the billing desk. Medicare Advantage plans denied 7.4% of prior authorization requests for orthopedic procedures in 2025, up from 5.9% in 2023. A […]
Yes — if your wound care billing company hasn’t restructured its skin substitute protocols, documentation workflows, and denial management infrastructure around the 2026 CMS reforms, it is actively costing your practice six figures or more in recoverable revenue this year. The wound care revenue environment shifted seismically on January 1, 2026. Under CMS Final Rule […]
Revenue leakage in OBGYN billing is the leading cause of suppressed Financial Performance in practices collecting $1M to $5M or more per month — driven not by fraud, but by global period miscoding, missed complication billing, and split-care modifier errors that compound silently across every billing cycle. What Is Revenue Leakage in OBGYN Billing? Revenue […]
Yes — if your Net Collection Ratio sits below 92%, your AR over 90 days has crossed the 20% threshold, or your denial rate is climbing past 5%, your medical billing company is underperforming and actively costing your group $150,000 to $400,000 in recoverable revenue every year. The damage rarely announces itself. Denial rates inch […]
Initial claim denial rates reached 11.8% in 2024 — up from 10.2% in 2020 — and payer audits rose 30% year-over-year in 2025. For physician practices and health systems, revenue integrity healthcare is no longer a back-office function. It is a financial survival strategy. Most healthcare organizations know they are losing revenue. The numbers they cannot explain […]
Yes, payer policies are complicating gynecology procedure billing—with OBGYN practices collecting $1M–$5M+ monthly experiencing 42–58% denial rates when variable payer policies create systematic confusion over global maternity package requirements, IUD insertion coverage, and Medicaid sterilization consent timing rules, costing $1.2M–$3.8M annually when practices apply single standardized workflows across all payers instead of payer-specific protocols, directly […]
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