RCM insights for growing practices
Practical, no-jargon guidance on billing, denials, credentialing and getting paid faster — written by the team that does this work every day, not a content mill.
Popular topics
- Billing
- Clean claims & charge capture
- Denials
- Prevention & appeals
- Credentialing
- Enrollment & revalidation
- A/R
- Days, aging & collections
Your clean-claim rate beats your fee schedule
A three-point jump in first-pass acceptance usually adds more to your bottom line than renegotiating a fee schedule. Every reworked claim burns staff time and delays cash, so fixing the front end pays you back first — and keeps paying.
The same-day visit you’re probably underbilling
When a patient comes in for a wellness visit and you also address a real problem, both are billable when you append modifier 25 to the problem visit. It’s one of the most commonly dropped charges in primary care.
Modifier 25: when it saves a claim, when it flags one
Modifier 25 rescues a legitimate same-day E/M performed alongside a procedure — but leaning on it too hard is an audit red flag. The fix is documentation that clearly separates the two services, not avoiding the modifier.
Enrollment gaps quietly cost you 60–90 days
A provider seeing patients before enrollment is final often means 60–90 days of revenue you can’t bill — or get clawed back later. Start credentialing the day you sign the contract, not the day they start seeing patients.
When a screening colonoscopy becomes diagnostic
Find and remove a polyp during a screening colonoscopy and the procedure is now diagnostic. Without modifier 33 or PT, the patient gets a surprise bill and you get a denial — a classic, avoidable GI revenue leak.
The three A/R numbers that actually matter
Days in A/R, the percentage over 90 days, and your net collection rate tell you in about thirty seconds whether your billing is healthy. If nobody is watching these every week, revenue is slipping and you can’t see it.
Want these fixes applied to your practice, not just your reading list?+1 786-788-7313Get a free audit