Working notes, not thought leadership
Written for somebody with the problem open right now
Notes on accounts receivable, denial codes, prior authorization, eligibility and certified payroll. No gates, no email capture, and every factual claim is either a public code set or clearly marked as our own working guidance.
Browse by topic
- Back-office support 20
- Medical Billing 12
- Operations 11
- Denials 10
- Revenue cycle 10
- Revenue Cycle Management 10
- Accounts receivable 9
- Front office 7
- Documentation 6
- Prior authorization 6
- Certified payroll 5
- Practice Operations 5
- Compliance 4
- Eligibility 4
- Specialty billing 4
- Credentialing 3
- Patient Experience 3
- Scheduling 3
How to write an appeal letter that actually gets a claim reopened
Most appeals ask the payer to please review the claim, and most are denied twice. The four parts that change that, and where each comes from.
How long can a payer take to decide a prior authorization?
Since 1 January 2026 there is a federal answer: 72 hours expedited, seven calendar days standard. Which payers it reaches, and which it does not.
What a denied claim actually costs to work, and what it costs to ignore
Two published figures decide it: what a rework costs, and how much of a denied claim is eventually paid when worked. Both are checkable.
What must be on a Good Faith Estimate, and when it has to be issued
Every element 45 CFR 149.610 requires, the four notices most templates leave out, and the three deadlines that govern it.
Days in AR: how to calculate it, and the number it hides
Four divisions give the figures every outside party asks for. Why most practices cannot produce them on the day, and which one matters.
How to overturn a timely filing denial
A timely filing denial is not always final, and the thing that overturns it is almost never an argument. It is a record showing the claim arrived on time.
What a good clean claim rate actually is
The number quoted everywhere is 95%. It is close to meaningless without a definition, and the definition is where practices and vendors quietly disagree.
Why prior authorizations get delayed, and how to stop it
Almost every authorization delay traces to one of eight causes, and six of them are inside the practice rather than at the payer.
Form WH-347, box by box
The federal certified payroll form, field by field, and the four boxes that account for most rejections.
Seven things that trigger a certified payroll audit
Reviewers look at a small number of things first. Each one is visible without reading a single wage rate, and each one is avoidable.
How to read an 835 remittance without missing money
The single highest-value skill on a billing floor. Six fields decide whether a balance is yours to chase, the patient’s to pay, or nobody’s.
How long payer enrollment actually takes
The honest ranges, what makes each one longer, and the dates that quietly deactivate a provider who is already enrolled.
The 8-minute rule, and the units it costs you
Timed codes are billed on total treatment time, not per code, and the two ways of counting produce different answers on the same visit.
Modifier 26 and TC: who bills which half
A diagnostic service can be two claims or one, and billing the wrong half is one of the quietest ways to lose money in radiology and cardiology.
Stop Anesthesia Revenue Leakage and Recover More From Every Claim
Anesthesia practices can lose revenue through coding errors, claim denials, documentation gaps, underpayments, and aging A/R. Learn how specialized anesthesia RCM, denial management, accurate billing, and proactive follow-up can reduce revenue leakage, improve collections, and strengthen cash flow.
Stop Gastroenterology Revenue Leakage Before It Hurts Your Bottom Line
Gastroenterology practices can lose valuable revenue through coding errors, claim denials, authorization gaps, eligibility issues, delayed submissions, payment posting mistakes, and aging A/R. This blog explores common GI billing challenges and how specialized gastroenterology medical billing and RCM services can improve claim accuracy, reduce revenue leakage, strengthen collections, and support h
How eligibility verification actually works
Most of what a practice loses to coverage problems is decided before the patient arrives. This is what a dedicated eligibility seat checks, when it checks it, and how to set the queue up so the front desk stops finding out at the counter.
How prior authorization works, start to finish
Authorization work fails in the gap between submitting and deciding. This is how to staff the chase, what to record, and how to stop authorizations expiring quietly before the service is rendered.
How denial management works, and what it costs to skip
Reworking denials one at a time is labour. Classifying them is the part that stops next month’s. This is how to run a denial queue that does both, and what to define before handing it to anybody.
How payment posting works, and where money hides
Payment posting decides what every other report in the practice says. Posted carelessly, it hides denials inside adjustments and makes the ageing report fiction. This is how to run it properly.
How charge entry and claim submission work
Charge lag is the cheapest problem in the revenue cycle to fix and the least often measured. This is how a dedicated charge entry seat runs, what it should scrub before submission, and what has to be decided first.
How medical coding works in a practice
Coding is the one back-office function where being fast and wrong is worse than being slow. This is how to set up an outsourced coding seat so the record leads and the query process actually works.
How provider credentialing works, and what stalls it
Credentialing is administratively simple and operationally brutal, because everything depends on dates nobody is watching. This is how to staff the chase and keep a calendar that prevents the expensive version.
How patient billing and statements work
Patient balances are the part of accounts receivable most likely to be billed wrongly and least likely to be chased consistently. This is how to run the cycle without damaging the relationship the practice depends on.
How scheduling, recall and no-show recovery work
An empty slot is not recoverable — the hour passes whether or not somebody is in it. This is how a dedicated seat fills the template, works the recall list, and gets cancellations back on the books the same day.
How referral intake and coordination work
A referral that arrives by fax and is never logged is a patient the practice never sees and a referrer who stops sending. This is how to run intake so every referral is tracked from arrival to booked visit.
What a virtual medical assistant actually does
A virtual medical assistant works if the role is scoped as a defined set of queues and fails if it is scoped as "help". This is the difference, in practical terms, and what to decide before the first day.
How hospital patient access and pre-registration work
Registration is where most denials are created and where almost none are detected. This is what pre-registration and financial clearance should cover, and how to staff it as a defined queue.
How release of information works, and the 30-day clock
Records requests are a queue with legal deadlines attached, handled in most practices by whoever has a spare afternoon. This is how to run it as a tracked function with an audit trail that survives being asked about.
How to find payer underpayments nobody is looking for
A denial announces itself. An underpayment does not — it looks exactly like a payment. This is how to build the comparison that finds them and the evidence that recovers them.
How workers’ compensation billing differs from commercial
These claims pay slowly, on different rules, to a different party, and they need a queue that is not the commercial one. This is what that queue has to contain.
How behavioural health and ABA billing work
This is authorization-unit accounting as much as billing. Run out of approved units mid-course and the sessions still happen — they just stop being billable.
How DME billing works, and why documentation decides it
In durable medical equipment the claim is the easy part. The documentation file behind it decides whether the claim survives, and it has to be complete before the item ships.
How dental billing and medical cross-coding work
Dental plans limit what they pay in ways medical plans do not — annual maximums, frequency limits, waiting periods, missing tooth clauses. Verification here is a treatment-planning input, not a formality.
How chronic care management and RPM billing work
These programmes are administratively heavy and clinically light, which is why they stall. This is what the administrative layer has to do for the clinical work to be billable.
How certified payroll filing works, week by week
Certified payroll is a weekly deadline that never moves, on projects with different rules each. This is what a dedicated seat does, and what a contractor has to define first.
What to actually ask about offshore data security
HIPAA does not prohibit offshore work. What it requires is specific, and most vendor security pages answer a different question.
Volume is the same but the deposit is smaller. Where did it go?
Same schedule, same providers, smaller cheque. There are five places the money goes, and three reports you already have will tell you which one.
How much should medical billing cost? The published numbers
Percentage of collections, per claim, flat monthly, or a salary. What each one actually costs a practice, with the figures the vendors themselves publish.
Why insurers deny claims, and which denials are worth fighting
Most denials are recoverable and most are never worked. The published data on denial rates, what it costs to fight one, and how to decide which to chase.
In-house biller or outsourced? An honest decision framework
When hiring locally is genuinely right, when it is not, and the cost comparison that uses what an employer actually pays rather than the salary line.
Switching billing companies without losing a month of revenue
The handover is where the money is lost — in the claims in flight and the ageing report nobody agreed to own. A sequence that protects both.
Days in AR: what the number hides and how to move it
A single average conceals the accounts that are actually costing you. The three cuts of the same data that tell you where the labour should go.
Seven signs your billing company is underperforming
Most practices find out late, because the reporting they receive is designed to look reassuring. What to ask for, and what the answers should be.
What breaks at two, five and ten providers
Billing does not degrade smoothly as a practice grows. It breaks at predictable sizes, and each break has a different fix.
Why claims sit at 90 days, and what actually moves them
A balance passes 90 days for one of four reasons, and only one of them is the payer’s fault. This is how to tell them apart before spending labour on the wrong pile.
The prior authorisation checklist that prevents CO-197
CO-197 is the most preventable denial in medicine. Six checks before the visit stop almost all of them, and each takes under a minute.
The five reasons certified payroll comes back rejected
In order of how often we see them in public filing data, and why the fifth is the one that holds up a progress payment.
Twelve questions to ask any offshore billing vendor
Including the four we would find awkward. A vendor that cannot answer these plainly is telling you something.
The eligibility checks that pay for themselves
Verifying at registration instead of at every visit is the cheapest mistake in a practice. Three denial codes explain why.
Days in AR: what good actually looks like
The benchmark everyone quotes is 30 to 40 days. That number is useless on its own, and this explains what to measure instead.
What a missed revalidation actually costs
It is never one claim. A lapsed enrolment stops payment on everything behind it, and the recovery window is measured in weeks.
Fringe benefits on certified payroll, explained properly
The second most common rejection, and the one that turns into a back-wage finding rather than a bounced filing.
The prior authorization checklist that prevents CO-197
CO-197 is the most preventable denial in medicine. Six checks before the visit stop almost all of them, and each takes under a minute.
If this is work somebody on your team is doing at four in the afternoon, it can be a seat.
Next step
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