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Latest posts
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🛡️ Audit-Proofing Your Practice: Preparing for the Rise in Payer Retrospective Reviews
Retrospective Audits Are on the Rise In the past, most payer audits focused on prepayment reviews or prior authorization compliance. But not anymore. Retrospective audits—where payers request documentation months or even years after payment—are rapidly increasing.And they’re not just looking for errors—they’re looking for money to claw back. Why the increase? The Hidden Cost of…
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🌀 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 confusion—or as many denials—as 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 Rise of Retrospective Recoupments: How to Shield Your Revenue Before Payers Strike
Your Reimbursement Isn’t Safe—Even After Payment Clears In a post-COVID environment defined by financial recovery and aggressive payer behavior, practices can no longer rely on “paid claims” 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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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 &…