Operational guidance on medical billing, coding accuracy, denial prevention, credentialing and reimbursement — written for healthcare administrators, practice managers and physician leaders working in the US payer environment.
Days in AR is the single most useful financial KPI for a billing operation. This article walks through how to segment aging by payer and bucket, where the most recoverable dollars actually live and how to set realistic AR targets by specialty.
Read related serviceMost denials labeled as billing problems originate at registration. Coverage status, plan changes, secondary insurance and prior authorization requirements are routinely missed at intake — and surface weeks later as denied claims.
Read related serviceRAF scores only hold up under RADV review when each captured chronic condition is supported by documentation that shows the condition was monitored, evaluated, assessed and treated on that date of service.
Read related serviceEvery uncredentialed day for a new provider is suppressed revenue. Treating credentialing as an active workflow with weekly payer follow-up, document expiration tracking and re-credentialing calendars protects cash flow at provider start dates.
Read related serviceThese two modifiers continue to generate the highest volume of NCCI-driven denials. A short refresher on the documentation that must support each, and the payer policies that override AMA guidance in practice.
Read related servicePosted payments that match the allowed amount are not automatically correct payments. Loading fee schedules and contract terms into the billing system makes underpayment identification a routine check rather than an occasional discovery.
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