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Payer policy changes, denial patterns and coding rules, written for independent practice owners. Every figure is dated and sourced.
A CMS proposed rule would make Medicare Advantage plans check provider listings every 90 days and post accuracy letter grades. Here is what small practices should do before contract year 2028.
CMS will suspend HETS EDI enrollments after three failed monthly emails, cutting off Medicare eligibility checks for that NPI. Here is how small practices fix it before December 1, 2026.
Medical billing is one stage inside revenue cycle management. See the difference, when the revenue cycle ends, and what end to end RCM covers.
Independent practices that outsource billing to a specialty-focused partner typically see denial rates well under the 2026 national average of 11.81 percent, days in accounts receivable that track closer to what MGMA calls its Better Performers, and staffing coverage that…
At $150,000 to $600,000 in monthly collections, a flat monthly fee almost always carries the lower sticker price. A typical flat quote for a 3 to 5 provider practice runs $1,500 to $3,500 a month, which works out to well…
The share of physicians in private practice fell from 60.1 percent in 2012 to 42.2 percent in 2024, according to the American Medical Association’s own benchmark survey. Hospital and corporate employment kept climbing every year in between. By the numbers,…
A one day delay in credentialing a new provider costs a medical group roughly 10,122 dollars in lost billing capacity, according to the survey MGMA still cites as the industry benchmark. Almost a third of medical groups now report some…
Gold carding exempts a provider from prior authorization on a specific service once they clear roughly a 90 percent approval rate over a 6 to 12 month lookback. It is not one federal program. It is a patchwork of state…
The national initial denial rate hit 11.81 percent in 2024, and 41 percent of providers now report a denial rate of 10 percent or higher. If your practice sits above roughly 12 percent, you are no longer in line with…
CMS has proposed cutting the Medicare conversion factor again for 2027, once the temporary 2.5 percent bump from 2026 legislation expires. Non qualifying physicians would see 32.84 dollars per relative value unit, a 1.68 percent cut from 2026’s 33.40 dollars.…
