What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

What Clean Claim Rate Should Dermatology Billing Guarantee?

A dermatology billing partner should guarantee at least a 97% clean claim rate measured at payer acceptance, and that guarantee only means something when the contract also ties it to First-Pass Yield and Net Collection Ratio. On its own, the clean claim rate is the easiest number in revenue cycle management to inflate. Dermatology is […]

Your Acuity Didn’t Drop. Your PDGM Reimbursement Did. Here’s Why.

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 […]

Can Optometry Denial Management Reduce Timely Filing Losses with Root Cause Data?

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 Collects $100K to $150K a Month, Here’s What Your Denial Report Isn’t Showing You

Wound Care Denial Management for $100K-$150K/Month Practices | MBC

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 […]

Optometry Billing Services: Is Your NCR Below the 2026 Benchmark?

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 […]

Family Practice Denial Management: Why Denials Quietly Become Unrecoverable Write-Offs

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, […]

Does Optometry RCM Services Improve NCR in 90 Days or Less?

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 […]

Is Your Wound Care Group’s Denial Rate Hiding a Six-Figure Appeal Problem?

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 […]

Why MA Denials Are Rising & What SNF Billing Fixes It

Why Medicare Advantage Denials Are Rising, and What Strong SNF Billing Services Do About It

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 […]

The Transitional Care Management Codes Most Practices Forget, and How Primary Care Billing Services Catch Them

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 […]

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