Is the 2.5% CMS Cut Draining Your Orthopedic Reimbursement?

Yes, for most procedure-heavy orthopedic groups, the CY 2026 Medicare Physician Fee Schedule quietly reduces orthopedic reimbursement even though the headline conversion factor went up. CMS finalized a 3.26% to 3.77% increase to the conversion factor for 2026, but it paired that increase with a −2.5% “efficiency adjustment” applied to work RVUs on nearly every […]

Is Your Skin Substitute Billing Compliant With CMS’s New Rate?

No, your skin substitute billing is likely not compliant if you are still coding and pricing products under the old per-product ASP methodology. Effective January 1, 2026, CMS replaced individual product-based payment with a single flat national rate of $127.14 per square centimeter for most skin substitutes used in physician offices and hospital outpatient departments. […]

Why OBGYN Denial Management Needs Executive Attention in 2026

OBGYN denial management needs executive attention in 2026 because global maternity bundling errors, modifier 25 disputes on same-day preventive visits, and missed gynecologic add-on codes have moved from routine billing friction into a recurring drag on practice-level EBITDA that billing staff alone cannot resolve. What Is OBGYN Denial Management? OBGYN denial management is the structured […]

Why Internal Medicine Denial Management Is Becoming a CFO-Level Metric

Internal Medicine Denial Management has moved off the billing floor and onto the CFO’s dashboard because unresolved denials now sit directly on top of practice EBITDA, not buried in a monthly claims report. What Is Internal Medicine Denial Management? Internal Medicine Denial Management is the structured process of identifying, correcting, appealing, and preventing insurance claim […]

What Happens During Medical Billing Onboarding?

Medical billing onboarding is the structured process of transferring a healthcare organization’s revenue cycle operations to a new billing partner. It covers data migration, payer credentialing checks, coding protocol setup, clearinghouse configuration, and staff training, typically completed in 30 to 45 days before the first claim is submitted. For CFOs and practice administrators, this window […]

Revenue Cycle Management Trends Every Healthcare CFO Should Know

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 […]

Why ASC Denial Management Is Becoming an EBITDA Protection Strategy

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 […]

Is Your GI Billing Process Ready for CPT 2027?

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: Which Is Better?

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: Finding the Right Balance

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 […]

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