1. It’s a New Era for Medicare Reimbursement Beginning in 2026, the Centers for Medicare & Medicaid Services (CMS) will permanently split the Medicare Conversion Factor (CF). Under this new structure: Advanced APM participants receive a higher Conversion Factor...
In our rapidly evolving healthcare business and regulatory environment, medical practices and physicians are no longer satisfied with legacy revenue cycle management (RCM) software that simply automates claim submission, posting, and denials follow-up. What they truly want is revenue intelligence a deeper, smarter, predictive capability that anticipates issues
Explore how Automated Eligibility Checking, Sophisticated Claims Edits, and the power of AI/RPA transform the third pillar of the People, Process, and Technology (P-P-T) framework, making your RCM strategy resilient, efficient, and profitable. Learn to leverage technology to prevent denials at the source and secure your financial future.
Time is money: managing your workforce is the new frontier of RCM. Stitch PEO, a UnisLink Channel Partner, reveals the 5 advantages of PEOs for medical practices. Stabilize costs, gain Fortune 500 benefits, and offload critical compliance risk (HIPAA, Stark Law) to free up time for patient care.
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.
Learn to decode denial codes (CARCs vs. RARCs), analyze the most frequent denial reasons, and measure performance using key KPIs like the Initial Denial Rate. Crucially, we provide the formulas to calculate the true administrative cost of working denials and the net financial value of your recovery efforts.
Stop losing revenue to denied claims! Learn what the prefixes (CO, PR, OA, PI) mean and discover the shocking truth: 48% of initial denials stem from eligibility issues—a problem you can fix before the patient is even seen. Master the codes and the data to fix the operational breakdowns that are costing you cash.
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.