With 30 years of experience, I excel in all aspects of practice management, covering front desk operations, clinical procedures, practice administration, accounting, and revenue cycle management (RCM).
In today’s complex billing landscape, accuracy is everything. With up to 80% of U.S. medical bills reportedly containing errors, even small missteps in coding can snowball into denied claims, delayed reimbursements, or regulatory audits. For healthcare practices, especially those involved in lab testing, understanding and effectively using Proprietary Laboratory Analyses (PLA) codes is essential to […]
Revenue loss due to claim denials is one of the most persistent challenges for healthcare practices. In fact, according to a 2021 study, nearly 17% of in-network claims submitted via healthcare.gov were denied—totaling approximately 48 million out of 292 million claims. For healthcare providers, this translates into delayed payments, lost revenue, and administrative headaches. At […]
Medical billing denials are a significant challenge for healthcare practices. Did you know that private payers initially deny 15% of medical claims? According to a national survey by Premier Inc., hospitals and healthcare systems spend an average of $438 per claim to dispute denials. With insurers reviewing nearly 3 billion claims annually, this results in […]
Claim denials can significantly impact revenue for healthcare practices. Understanding common denial categories and how to prevent them can streamline billing operations and improve cash flow. This article breaks down the most frequent claim denial types and provides actionable solutions. Coverage and Eligibility Denials These denials occur when a patient’s insurance is inactive, expired, or […]
Denied claims are a significant issue in healthcare revenue cycle management. In 2024 alone, over 48 million healthcare claims were denied, creating financial and administrative burdens for practices. While completely eliminating denials is unrealistic, understanding common denial codes and implementing prevention strategies can drastically reduce their occurrence. One of the most frequent denial codes is […]
Medical claim denials are a major challenge for healthcare practices. Understanding common denial codes can help mitigate claim rejections and improve reimbursement rates. One such code is Denial Code PR 272, which indicates that a service is not covered by the patient’s insurance policy. This article explores the causes of PR 272, strategies to prevent […]
Understanding Denial Code CO 273: A Comprehensive Guide for Healthcare Practices Claim denials are a common challenge in the medical billing world, with up to 30% of claims facing denial for various reasons. Among these, denial codes serve as essential messages from insurance companies, explaining why a claim cannot be processed. A particularly notable example […]
2025 CPT Updates for Dermatology and Surgery: Key Changes and Practice Impact As the healthcare landscape shifts, dermatology and surgical practices must adapt to new coding and guideline updates to maintain operational efficiency and compliance. The 2025 CPT updates bring targeted changes that directly affect these specialties. Here’s a detailed breakdown of the updates and […]
As we approach 2025, the latest CPT (Current Procedural Terminology) updates are set to reshape coding and billing processes for healthcare practices. Understanding these changes is crucial to maintaining compliance, streamlining workflows, and maximizing revenue. Here, we break down the key updates and their potential impact on your practice. Overview of the 2025 CPT Changes […]
As we approach 2025, the Merit-based Incentive Payment System (MIPS) continues to evolve, introducing new challenges and opportunities for healthcare providers. The latest updates bring significant changes across various performance categories, including quality measures, cost measures, and improvement activities. Here’s an overview of the key updates. Threshold and Data Completeness To avoid a negative payment […]
