2027 Prior Authorization Changes: A Practice Readiness Checklist
Starting January 1, 2027, certain health insurance payers must begin meeting new electronic prior authorization and healthcare data-sharing requirements under the CMS Interoperability and Prior Authorization Final Rule. For medical practices, this creates an opportunity to reduce manual authorization work, improve visibility into payer decisions, and coordinate treatment approvals more efficiently. But what exactly changes […]
Medical Billing Vendor Transition Checklist for Multi-Provider Practices
Switching medical billing companies can become complicated when a practice has multiple physicians, locations, and insurance contracts. One provider may be enrolled with Medicare under the practice’s billing group, while another has different commercial payer participation. A third may perform procedures at multiple facilities with separate billing requirements. If the incoming billing company overlooks these […]
Revenue Cycle Handoff Failures: When Scheduling, Authorization and Coding Do Not Match
A patient schedules a procedure, the authorization team obtains insurance approval, and the coding department prepares the claim after treatment. Each department completes its assigned task. Yet the claim is delayed or denied because the information recorded at one stage no longer matches what happened at another. Perhaps the procedure was moved to a different […]
Corrected Medical Claims vs Appeals: How to Choose the Right Resolution
A medical practice receives a denied claim for $2,800. The billing team reviews the payer’s response and discovers that something went wrong. But should they correct the claim and submit it again, or challenge the insurance company’s decision through an appeal? Choosing the wrong option can delay reimbursement, create duplicate submissions, or cause the practice […]
How to Build a Monthly Medical Billing Performance Dashboard for Practice Owners
Your medical practice generated $240,000 in charges last month and collected $178,000 in payments. At first glance, those numbers might seem encouraging. But how much of that revenue was actually collectible? How many claims were denied? Which insurance companies are taking longer to pay? And how much money is sitting in accounts receivable without a […]
Medical Necessity Denial Appeals: What Supporting Documentation Should Practices Submit?
A physician examines a patient, recommends treatment, and documents the medical condition. The service is provided, the claim is submitted, and the practice expects reimbursement. Instead, the insurance company denies the claim because the treatment was not considered medically necessary. For healthcare practices, this can be frustrating. The physician believed the service was appropriate, but […]
How to Prioritize Aging Medical A/R by Recoverability, Balance and Filing Deadline
Every medical practice has unpaid claims that need attention. Some are waiting for insurance processing, others have been denied, and a few may be approaching deadlines that could make reimbursement much harder to recover. The challenge is deciding which claims to work first. Many billing teams start with the oldest balances or the claims with […]
Claim Rejections vs Denials: Understanding 999, 277CA and 835 Responses
A medical practice submits an insurance claim and receives confirmation that the file was accepted. The billing team assumes everything is moving forward, but several days later, the claim still has not been paid. What went wrong? The answer often depends on which response the billing system received. A claim can be rejected before it […]
Authorization Approved but Claim Denied: CPT, Provider and Site-of-Service Mismatches
Your medical practice obtains prior authorization for a procedure, receives an approval number, and schedules the patient for treatment. The service is completed, the claim is submitted, and everything appears to be in order. Then the insurance company denies the claim. For billing teams, this can be particularly frustrating because the payer already approved the […]