Revenue Cycle Management Blog

The Denial Dilemma: Prevention, Prioritization, and the P-P-T Framework

The Denial Dilemma: Prevention, Prioritization, and the P-P-T Framework

Discover the P-P-T Framework (People, Process, Technology), a coordinated strategy for sustainable denial management. Learn critical KPIs (like Revenue Realization Rate and AR Over 120 Days) to assess staffing sufficiency and get guidance on how to prioritize the highest-impact denial problems by value and frequency, setting the stage for continuous revenue cycle improvement.

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The Transition from ICD-10 to ICD-11: A Fundamental Shift for U.S. Healthcare Practices

The Transition from ICD-10 to ICD-11: A Fundamental Shift for U.S. Healthcare Practices

The transition from ICD‑10 to ICD‑11 represents a significant change for U.S. healthcare practices. ICD-11 is already in effect globally, the U.S. has not yet set an official implementation date. Nonetheless, proactive preparation is vital for independent physicians and small group practices to ensure a smooth transition, maintain revenue flows, and avoid operational disruption. Learn what is changing, what to expect, and how to prepare for the transition.

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The Denial Dilemma: Why 1 in 5 Claims is Being Denied

The Denial Dilemma: Why 1 in 5 Claims is Being Denied

Denial of claims by insurance payers has become a widespread and escalating problem in the healthcare industry. These denials are not just administrative nuisances; they represent a significant threat to providers’ financial stability and a detriment to patient care. This article, the first in a five-part series, will examine the alarming statistics behind medical billing denials and their multifaceted impact on healthcare practices.

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