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Latest posts
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In-House vs. Outsourced vs. Hybrid Billing: Which Model Is Right for Your Practice?
Choosing the right billing model isn’t just about operations—it’s about outcomes.As RCM challenges grow more complex, providers across the country are asking a critical question: Should we handle billing in-house, outsource it, or create a hybrid solution? The right answer depends on your size, staffing, payer mix, and risk tolerance. But the consequences of getting…
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Telehealth Billing: Navigating the New Rules to Get Paid Faster: How to Avoid Costly Denials as CMS and Payers Tighten Virtual Care Requirements
The $3.2 Million Telehealth Mistake “A 35-provider behavioral health group lost $3.2M in 2024 revenue because their billing team missed just one CMS telehealth modifier update. With 2025’s expanded documentation requirements, such errors could bankrupt smaller practices.” Telehealth now accounts for 28% of all claims (FAIR Health), but payer rules are becoming more complex, not…
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The Hidden Revenue Killers in Your RCM Workflow—and How to Fix Them
Are silent revenue leaks sabotaging your revenue cycle performance?If your denial rates are creeping up, AR days are dragging on, or payer audits are catching you off guard—you’re not alone. Despite robust billing systems and EHR integrations, many healthcare organizations still face systemic RCM breakdowns that aren’t easily detected by standard metrics. The good news?…
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Front Desk Staff: Your Secret Weapon Against Claim Denials (2025 Edition)
How to Transform Patient Access Teams Into Your First Line of Defense The $87,000 Front Desk Mistake “A busy orthopedic clinic lost $87,000 in one quarter because front desk staff weren’t verifying Medicare Advantage plan changes at check-in. Every single claim was denied for eligibility – and all were preventable.” Your front desk staff handle…
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Out-of-State Blues: How to Prevent BCBS Denials from Out-of-State Plans
Every week, providers across the country are blindsided by unexpected denials from Blue Cross Blue Shield (BCBS)—even when they believe they’re in-network. The confusion often stems from out-of-state BCBS plans that follow different processing rules, network tiers, and policy-level restrictions. In 2023, out-of-network-related denials jumped by over 18%, especially for specialty clinics serving traveling patients,…
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Modifier 25 and Medicare Denials: How to Protect Office Visit Revenue in 2025
Medicare denials for office visits are on the rise—and Modifier 25 is one of the biggest culprits. If your practice is experiencing denials for E/M services billed on the same day as procedures, you’re not alone. In 2023, multiple Medicare Administrative Contractors (MACs) ramped up pre-payment edits and post-payment reviews targeting misuse of Modifier 25,…
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The 2025 RCM Vendor Audit: How to Protect Your Revenue in the Era of AI & Payer Complexity
New Benchmarks, AI Risks, and Proactive Audit Strategies The Coming Storm in Healthcare Billing “In 2024, a 300-provider multispecialty group lost $1.2M after their AI-powered RCM vendor ‘optimized’ claims into denial patterns. By the time they audited, 60% of appeals were time-barred.” 2025’s revenue cycle will bring: ✅ AI-driven claims processing (with new failure points)…
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How to Audit Your RCM Vendor (Before It’s Too Late)
Red Flags, Key Metrics, and Steps to Protect Your Revenue A Cautionary Tale “A mid-sized cardiology group discovered their billing company had been underreporting denials by 40%—costing them over $200,000 in recoverable revenue. By the time they audited their vendor, it was too late to reclaim most losses.” If you outsource your revenue cycle management…