Training and Education – The Key to RCM Resilience
The healthcare industry changes constantly, but staff training often lags. Without ongoing education, even experienced teams fall behind on coding, compliance and payer contract stipulations — leading to errors and denials. Training empowers staff to be more efficient, compliant and confident. Practices that prioritize education reduce denials and accelerate cash flow. They also boost morale […]
Denial Management – Playing Offense, Not Defense
Denials are rising across the board. Between 2023–2024, 60% of medical group leaders reported increases. In fact, payers denied nearly 1 in 5 in-network claims in 2023. Most denials are preventable. Oftentimes claims are submitted with incomplete information, missing documentation, coding errors, or lack of prior authorization. The challenge is bandwidth — short-staffed (and inexperienced) […]
Turning Data into Actionable Insights
Key Performance Indicators (KPIs) are the lifeblood of a healthy revenue cycle. From AR days to denial rates, these metrics show whether your workflows are on track or need adjustment. But too often, practices either drown in too many reports or lack the ability to uncover and act on the real insights. Predictive analytics and […]
RCM Workflows and Processes – Where Revenue Begins and Ends
Revenue cycle success depends on seamless workflows between front- and back-office teams. Yet, too often, eligibility isn’t checked, documentation is incomplete, or coding errors go unnoticed. The result? Nearly 30% of claims are lost or denied, and 65% of those denials are never reworked. That’s money left on the table. By focusing on up-to-date patient […]
Patient Satisfaction Begins with the Front Office
The patient experience starts long before they enter the exam room. Front-office staff who handle scheduling, registration and payment discussions set the tone for general information needs, satisfaction and ultimately, loyalty toward your practice. When staff shortages or inexperienced staff cause rushed interactions or incomplete registrations, patients feel overlooked. Worse, lack of communication about what […]
How to Prepare for CMS WISeR: A New Era of Pre-Service Review
Medicare is entering a new era of oversight. With the launch of the Wasteful and Inappropriate Service Reduction (WISeR) model on Jan. 1, 2026, CMS will shift from post-payment audits to technology-driven pre-service review and prior authorization — a move that mirrors commercial payer processes. Initially focused on select services in six states (Arizona, New […]
Why Front-End RCM is the Unsung Hero of a Healthy Revenue Cycle
When it comes to revenue cycle management (RCM), most conversations revolve around billing, coding and collections. Yet the most preventable problems — and the biggest opportunities for improvement — lie at the very start. Front-end RCM processes such as insurance verification, accurate patient registration and point-of-service collections are essential to a healthy revenue cycle. In […]