Practical RCM analysis from nearly two decades of hands-on billing operations, by the ABA editorial team.
MGMA data shows practices lose 5–7% of net revenue to underpayments annually. How to audit payer remittances, spot the five most common patterns, and recover what you're owed through disputes that succeed 60–70% of the time.
Two-track conversion factors ($33.5675 APM / $33.4009 non-APM), the 2.5% efficiency adjustment on 9,000 codes, 285 inpatient-only procedures moving outpatient, and MIPS at 75 points — everything billing teams need to act on now.
How to bill CCM, TCM, AWV, and RPM codes your FFS team is missing, score above the 75-point MIPS threshold, and capture the APM conversion factor advantage before ACO REACH ends December 31.
AI is changing medical billing — but not the way the headlines claim. A ground-level look at what's actually being automated, where human expertise still wins, and what it means for your practice.
Medicare telehealth billing changed significantly in 2026. New codes, modifier 95 vs 93, POS 02 vs 10, the October RHC/FQHC shift — here is what your billing team needs to get right.
Credentialing delays mean you cannot bill in-network — and every day costs real money. Realistic timelines by payer, what it actually costs, and when outsourcing pays for itself.
Getting managed care contracts is the #1 challenge new and growing practices face. Here's the full process — credentialing vs contracting, fee schedule negotiation, and what to read before you sign.
A claim denial rate above 10% is not bad luck — it's a systemic problem. Here are 7 proven strategies to cut it in half, based on what works in real billing operations across multiple specialties.
When all hidden costs are included, in-house billing typically costs 8–15% of collections. Outsourced billing runs 3–10% — and often delivers better results.
Most claim denials fall into 10 predictable categories. Here's what each one means and exactly how to prevent it before the claim leaves your practice.
Denial rates that don't improve, AR that keeps aging, no transparent reporting — these aren't bumps. They're warnings. Here's what to look for and what to do.
Under 30 days in AR is excellent. Over 50 days is a problem. Here are the current benchmarks by specialty and what to do if yours is too high.
Authorization issues drive up to 30% of DME claim denials. Here's the exact workflow that prevents them — before a single claim gets submitted.
27% of all claim denials trace back to eligibility errors at the front desk. Here's the verification workflow that eliminates them.
More articles publishing weekly — download the free Denial Prevention Checklist to be notified.
Checklists, benchmark reports, calculators, and playbooks — built for provider decision-makers, not students.