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 [...]
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 [...]
Patient-Centric Medical Billing is transforming the healthcare industry by prioritizing transparency, simplicity, and empathy in the billing process. Unlike traditional medical billing, which often leaves patients confused and frustrated, patient-centric billing focuses on clear communication and support to enhance the overall patient experience. In an era where patient satisfaction is [...]
The U.S. healthcare industry is experiencing a significant increase in labor costs, affecting hospitals and healthcare providers nationwide. Rising wages, workforce shortages, and burnout-related turnover are straining hospital budgets, making financial sustainability a pressing concern. For hospitals that rely on efficient revenue cycle management (RCM) to maintain profitability, this trend [...]
Medical billing compliance is crucial for healthcare providers to avoid financial penalties, legal actions, and revenue losses. Strict regulations such as HIPAA, the False Claims Act, and Medicare guidelines demand accuracy and transparency in billing practices. Non-compliance can result in audits, claim denials, and hefty fines. In this blog, we’ll [...]