The Money You Can’t See on Your Denial Report
Every revenue cycle meeting starts with the same chart. Denial rate, month over month, usually trending down if the practice…
When a Payer Policy Changes, Who Actually Updates the Claim?
A payer publishes a policy bulletin. Somewhere in a portal, a newsletter, or an email, a change takes effect: a…
The Referral Was Made. The Patient Was Seen. The Practice Still Lost the Revenue.
The referral went out. The patient made the appointment. The specialist saw them, documented the visit, and submitted the claim.…
Your Payer Contract May Be Paying You Less Than You Think
A contract is signed once. It is rarely read again. Most practices treat a payer contract as a fixed reference…
The Claim Was Paid. So Why Is Your Revenue Still Wrong?
A claim goes out. A payment comes back. The balance drops to zero, and the account closes. In most billing…
The $700,000 HIPAA Lesson Hidden Inside One Phishing Attack
A phishing attack compromised one employee’s email account. That’s how this story starts. But the $700,000 figure at the end…
Your Claims Aren’t Being Denied. They’re Being Taken Back.
Why lower denial rates may be hiding a new revenue-cycle problem for medical practices Here’s a number that should stop…
Aetna Is Changing Cancer Prior Authorization. Here’s What Oncology Practices Need to Know
If you run an oncology practice that sees Aetna patients, you already know the drill: diagnosis, then paperwork, then more…
The Medicare Advantage DMEPOS Gap Every Prescribing Physician Should Know About
By Elena Pak, Credentialing Department, WCH Quick question: when you write a durable medical equipment order for a Medicare Advantage…
Why Anthem Is Penalizing In-Network Hospitals for Out-of-Network Doctors
By Elena Pak, Credentialing Department, WCH Elevance Health, the parent company of Anthem Blue Cross Blue Shield, is facing another…