Category: Revenue Cycle Management
CY2027 Medicare PFS Proposed Rule: Specialty-by-Specialty Impact Guide
The CY2027 PFS proposed rule cuts the conversion factor to $32.84 for non-APM clinicians, but the real story...
Real-time eligibility returned active and the claim still denied: the five reasons why
An “active” eligibility result only proves the policy is in force. It never proves the service is covered, that...
Prior authorization turnaround requirements under the CMS interoperability rule: what changed for practices
The CMS interoperability rule (CMS-0057-F) forces impacted payers to decide standard prior authorizations in 7 calendar days and...
Appeal or Write Off? A Decision Framework for Denied Claims Over $500
Don’t let the dollar amount make the call by itself. Sort the denial by reason code, run the...
Switching RCM Vendors Mid-Contract: What Actually Breaks During the Handoff
Switching RCM vendors before a contract ends feels like the fast fix for a billing team that’s underperforming....
Medical Coding Errors That Cost Practices the Most (And How to Catch Them Before They Submit)
Medical Coding Errors That Cost Practices the Most (And How to Catch Them Before They Submit) Written by the...
What Is Insurance Verification and Why It Matters
Insurance verification is the front-end process that determines whether a claim will be paid before the patient ever enters...
Insurance Denial Appeals: What Practices Miss
Most insurance denial appeals that fail don’t fail because the clinical case was weak. They fail because the...
What Is Aging Accounts Receivable in Medical Billing
Aging accounts receivable is the financial picture of revenue owed but not yet collected, organized by how long it...