The 25-denial pilot behind a reported $40M recovery
An operator teardown of a vendor-reported hospital denial program that tested 25 cases before scaling to a reported $40 million recovery.
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Practical perspectives on the systems, decisions and people behind the revenue cycle. Written to be discussed, questioned and put to work.
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Preliminary 2027 lab rates still require action
A practical code-level review for laboratories and practices preparing for CMS's preliminary CY 2027 Clinical Laboratory Fee Schedule rates.
Read the field note ↗︎Denial prevention vs. denial rework: two operating loops
A practical operating model for resolving individual denials while testing upstream prevention changes without confusing activity with improvement.
Read the field note ↗︎Your CY 2024 MIPS performance is now public
A practical audit plan for reviewing clinician and group Quality Payment Program information now published in the CMS Provider Data Catalog and Medicare Care Compare.
Read the field note ↗︎A 2% payer underpayment became a $125,000 recovery
What Adirondack Health’s public case shows about contract variance, underpayment detection, and why a clean denial queue can still hide revenue leakage.
Read the field note ↗︎SNF FY 2025 PEPPER: outlier status is not a billing verdict
How skilled nursing facilities can use the FY 2025 PEPPER to prioritize targeted claim, coding, documentation, medical-necessity, and length-of-stay review without treating an outlier as proof of error.
Read the field note ↗︎Selected for Medicare ASM? The 2027 work starts now
A practical readiness plan for specialists selected for Medicare’s mandatory Ambulatory Specialty Model, from TIN–NPI confirmation to reporting ownership and payment-adjustment controls.
Read the field note ↗︎ACCESS Co-Management Payment: a care update alone is not billable
A practical billing workflow for Medicare ACCESS Co-Management Payments, including practitioner review, care-coordination action, time, diagnosis, documentation, and frequency controls.
Read the field note ↗︎FY 2027 ICD-10-CM: prepare before October 1
A practical pre-October checklist for updating coding references, systems, documentation prompts, claim edits, and denial monitoring before the FY 2027 ICD-10-CM update.
Read the field note ↗︎WISeR makes prior authorization a revenue-cycle workflow
Under Medicare’s WISeR model, providers in six states must operationalize a choice between prior authorization and post-service, pre-payment review for selected services.
Read the field note ↗︎CMS 2027 proposal: contractor-delivered RPM and RTM at risk
CMS proposes limiting Medicare RPM and RTM payment to services performed by practice-employed clinical staff. What practices should audit before 2027.
Read the field note ↗︎A/R follow-up is an operating system, not a task list
Why disciplined queues, clear ownership, and useful feedback matter more than simply touching more accounts.
Read the field note ↗︎Clean claims begin before charge entry
The quiet upstream decisions that determine whether a claim moves cleanly or becomes expensive rework.
Read the field note ↗︎What billing teams should measure beyond collections
Collections tell you what arrived. Operational measures tell you why—and what is likely to happen next.
Read the field note ↗︎Need a clear explanation of the basics first?
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