Revenue Cycle Management Blog
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.
The Denial Dilemma: Decoding Denials, Measuring Performance, and Calculating the True Cost
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.
The AMA’s 2026 CPT Updates: What Physician Groups Need to Know About AI-Augmented Codes
The AMA’s 2026 CPT code set introduces new codes for AI-augmented services in radiology, diagnostics, and pathology. Learn what these updates mean for independent physician groups, how they affect compliance and reimbursement, and what RCM teams can do now to prepare for this major industry shift.
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.
The Denial Dilemma: The Secret Language of Denials & Why You Need to Speak Fluent Code
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.
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.
RCM Top Metric: Monitoring Gross Collection Rate, Revenue Realization Rate, and Net Collection Rate
In this last article of our series on the seven most important RCM metrics, we’re focused on calculating gross and net collections and understanding how much of your earned revenue is truly hitting your bottom line.
RCM Top Metric: How to Calculate Your Denial Rate and Reduce Denied Claims
When healthcare providers regularly calculate claim denials and interpret this metric, it gives them a clear path to increasing cash flow, optimizing performance, and reducing administrative waste. In this article, we’ll help you learn to calculate your medical claim denial rate, why it’s important, what industry benchmarks to strive for, and how to reduce your denial rates over time.