Over the years, I have seen hundreds of behavioral health practices lose not just money but momentum because of claim denials that could have been prevented. In behavioral health, denials are more than just a paperwork issue. They reflect a system that often struggles to balance compassion and compliance. Clinicians [...]
In all my years working with healthcare providers, few areas have tested the limits of patience and process quite like behavioral health billing. It’s not just another medical specialty; it’s an entirely different world. Behavioral health care is not procedure-driven; it’s people-driven. Yet, when it comes to billing, most systems [...]
Over the last decade, healthcare providers have faced an uphill battle with tighter margins, complex payer rules, and ongoing staffing shortages that have reshaped how revenue cycle teams operate. But the biggest challenge of all isn’t change itself. It’s the speed at which it’s happening.When denials rise faster than your [...]
In my 25+ years working in revenue cycle management, I have seen practices succeed with in-house billing and I have seen many struggle. The truth is, managing billing internally is not just about having a few people handle claims. It requires a structured framework and a commitment to constant improvement. [...]
On October 1, 2025, payors and at least one major has announced they will start downcoding will implement policies that automatically reduce high-level Evaluation & Management (E/M) services when the submitted diagnosis does not justify the complexity of the visit. For many providers, this might sound like “just another payer [...]
In the world of behavioral health, clinical care is deeply personal. Every patient interaction is different, every session unfolds in its own way. But when it comes to billing, that same level of nuance must be translated into structured, standardized codes. And that’s where many behavioral health providers hit a [...]
Eligibility denials are a growing concern in urgent care billing. These silent revenue killers, often stemming from incorrect insurance data or missed benefit checks, can lead to significant losses if not proactively managed. For urgent care centers operating on tight margins and fast-paced workflows, overlooking eligibility verification can result in [...]
In 2025, healthcare is witnessing a profound transformation driven by cutting-edge technologies like Artificial Intelligence (AI) and automation. One of the most impacted areas is medical billing and revenue cycle management (RCM), where these innovations are revolutionizing workflows, boosting accuracy, and accelerating reimbursements. For healthcare providers, staying ahead means embracing [...]
Top 3 Billing Challenges for Urgent Care Centers (And How to Solve Them) Urgent care centers play a crucial role in modern healthcare, providing fast, accessible care for patients who need immediate attention but not an emergency room visit. But while patient care moves quickly, the billing process can often [...]
When it comes to managing the financial health of your practice, billing audits are one of the most effective tools at your disposal. It’s not just about compliance; it’s about maximizing revenue, preventing denials, and securing the long-term sustainability of your practice. However, many practices overlook the power of routine [...]