The Claim Was Correct. The Patient Still Got the Bill.
When does a “paid claim” become a patient-balance problem? Usually weeks before anyone prints the statement. Picture a patient walking…
Category: Business View
Your Practice Has a New Doctor. Why Are the Claims Still Going to the Old One?
The NPI followed the physician. The payer records didn’t necessarily follow. Here’s how an enrollment mismatch can turn a routine…
Medicare Advantage Is Reshuffling for 2027. What Does It Mean for Providers?
By Lilit Muradyan, Billing Department, WCH Plan exits and network changes can create new credentialing, eligibility, authorization, and billing…
CMS Says It Stopped $1.6 Billion in Potentially Improper Lab Payments. The Bigger Story Is How.
By Tatyana Kantor, CFPC, CPB, Billing Department WCH; President of AAPC Chapter in Central Asia CMS says its enforcement actions…
CMS Is Tightening the Rules on Medicare Advantage Chart Reviews. What Providers Need to Know Before 2027
By Elizaveta Bannova, Billing Department, WCH
75% of Providers Get This Medicare Telehealth Question Wrong. Does Your Practice?
By Elena Pak, Credentialing Department, WCH Here’s a number that should make every practice manager sit up: when the Center…
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.…
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…