Latest posts
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āļø When AI Misses the Mark: Preventing Automation-Driven Errors in RCM
The Promise and Peril of AI in Revenue Cycle Artificial Intelligence (AI) has moved from buzzword to baseline in healthcare revenue cycle operations. Today, practices use AI for: But hereās the catch: AI only works as well as its rules, data, and oversight. And when those fail? You donāt just lose efficiencyāyou lose revenue. Common…
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Beyond the Write-Off: How to Prevent Avoidable Patient Bad Debt
Itās easy to chalk up patient balances to bad debt and move onābut doing so quietly drains long-term revenue and damages patient trust. The real issue isnāt patients refusing to pay; itās the systemic breakdowns in communication, timing, and expectation-setting that make payment unlikely from the start. As high-deductible plans continue to rise and patients…
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Appeals That Actually Win: Beyond Templates to Root-Cause Fixes
When Copy-Paste Appeals Stop Working Two months ago, Jason, the revenue cycle director at a midāsized orthopedic practice, noticed a troubling trend. His team was sending appeal letters for denied claims faster than ever, using the same ātriedāandātrueā templates theyād relied on for years. But payer overturn rates were slippingāfrom 68% to just 41%. The…
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šÆ Chasing the Wrong Denials: How to Prioritize High-Impact Appeals
Not All Denials Are Worth It Letās be honest: appealing every denial isnāt efficientāitās exhausting. Too many revenue cycle teams default to working appeals based on when they show up in the queue, not based on strategic value. The result? Itās time to stop treating all denials the same. The Real Cost of Low-Value Appeals…
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When Clean Claims Go Dirty: The Hidden Errors Sabotaging Your Reimbursements
The Day the Cash Flow Slowed to a Crawl Last summer, Maria, the practice manager of a busy rural cardiology clinic, was feeling confident. The team had just hit a 94% clean-claim submission rateāa figure that meant faster payments and fewer headaches. But by October, things had changed. Reimbursement timelines were stretching, denials were piling…
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The Credentialing Trap: How Delays at the Start Cripple Your Revenue Cycle
Credentialing is often treated as a standalone taskāan administrative checklist that simply needs to be completed before a provider can see patients. But this mindset underestimates the far-reaching consequences of getting it wrong. When credentialing delays occur, the impact ripples downstream: denied claims, unbilled visits, and mounting frustration for patients and staff alike. More Than…
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š Training Fatigue: Why Annual Compliance Training Isnāt Enough
The Problem with the Once-a-Year Approach Letās face it: most annual compliance training is forgettable.Employees click through generic modules, pass a quiz, and move onāonly to forget 80% of what they learned within a few weeks. In high-risk environments like billing, coding, patient access, and clinical documentation, this leads to: Annual training may check the…
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Lost in the Loop: Why Claim Status Codes Arenāt Giving You the Full Picture
Claim status codes were designed to bring clarityābut for most billing teams, theyāve done the opposite. Instead of delivering transparency, these standardized codes often offer vague or incomplete answers that lead to more questions, longer resolution times, and frustrating payer phone calls. When a claim is stuck in limbo, relying solely on the status code…