Latest posts
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š Appeal or Abandon? A Data-Driven Framework for Smart Denial Triage
The Appeal Dilemma Denials are inevitableābut wasted appeals are optional.Many revenue cycle teams treat denials reactively: appeal everything, escalate if denied again, and hope something sticks. This approach is: Not all denials deserve your time. The question isnāt just can you appeal, but should you? Denial Volume ā Denial Value Denial rates get attention, but…
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š©ŗ Time to Talk TAT: Why Turnaround Time Should Be a KPI in Your Revenue Cycle
What Is Turnaround Time ā and Why Does It Matter? Turnaround time (TAT) refers to the time it takes for a task or process in the revenue cycle to be completed from start to finish. Whether it’s submitting a claim, receiving a payment, responding to a denial, or obtaining prior authorization ā the speed of…
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Why One Code Doesnāt Fit All
Navigating CPT/HCPCS Variations Across Medicare Advantage Plans Why Billing Medicare Advantage Isnāt One-Size-Fits-All If youāve ever billed the same CPT code to two different Medicare Advantage (MA) plans and received two completely different responsesācongratulations, youāre not alone. Unlike traditional Medicare, which follows consistent CMS-issued national policies (NCDs) and local coverage determinations (LCDs) by MACs, MA…
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Template Trouble: How Poor EHR Design Is Killing Clean Claims in 2025
š Your EHR Isnāt HelpingāItās Hurting Your Claims EHR templates were designed to streamline workflows, standardize notes, and help providers meet documentation requirements faster. But in 2025, theyāve become a top source of hidden claim contamination. At Thrive, weāve seen it firsthand: templates meant to speed things up actually introduce patterns that trigger payer audits,…
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š Modifier Madness: How Incorrect Usage of Modifier 59 and Its Alternatives Could Trigger Audits
In the world of Medicare billing, a single keystroke can separate clean reimbursement from costly recoupment. Few billing issues generate as much confusionāor as many denialsāas improper modifier usage. Among the most misused? Modifier 59, often applied in a last-ditch attempt to override Medicare edits. As a Medicare billing strategist with over 25 years of…
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The 5 Biggest Pain Points in FQHC Billingāand How to Solve Them
For Federally Qualified Health Centers (FQHCs), billing isnāt just complexāitās uniquely demanding.Unlike traditional provider organizations, FQHCs face a highly regulated, grant-funded, and payer-diverse environment that introduces billing, compliance, and documentation hurdles at every stage of the revenue cycle. From flat PPS reimbursements to HRSA audit exposure and Medicaid-specific rules, most FQHC billing teams are forced…
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The Rise of Retrospective Recoupments: How to Shield Your Revenue Before Payers Strike
Your Reimbursement Isnāt SafeāEven After Payment Clears In a post-COVID environment defined by financial recovery and aggressive payer behavior, practices can no longer rely on āpaid claimsā as final income. In 2025, retrospective audits and recoupments have skyrocketed, with many providers facing six-figure clawbacks on claims previously thought resolved. One Texas orthopedic group saw $860,000…
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šø The $100K Denial Problem: Why Medicare Billing Mistakes Are Costing Providers More Than Ever
Unresolved Medicare denials arenāt just an administrative hassleātheyāre silent revenue killers. Across the country, providers are leaving tens of thousandsāsometimes hundreds of thousandsāof dollars on the table each year due to preventable billing and coding errors. Whatās worse? Many donāt realize it until itās too late for appeals or corrections. As a 25-year Medicare RCM…
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The $500,000 Lesson: Why Every Revenue Cycle Team Must Document Like Lawyers
How Clear Notes in EHRs Save Revenue, Reduce Call Volume, and Win Appeal “A hospital lost $497,000 because a front desk note simply said ‘insurance verified’ instead of including the verification number. The judge called it ‘insufficient evidence’ – and that’s becoming the rule, not the exception.”* Why Your EHR Notes Are Now Legal &…
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The Top 5 AI Trends Transforming Healthcare Revenue Cycle Management in 2025
AI is no longer coming for the revenue cycleāitās already here.From automated eligibility verification to predictive denials and real-time audit readiness, artificial intelligence is rapidly transforming how providers manage the business of healthcare. And while AI holds the potential to eliminate friction and accelerate cash flow, poor implementationāor failure to adaptācan introduce just as many…