Most providers don’t have the time—or desire—to get into the weeds of payor contracting. Contracts are signed, stored away, and rarely looked at again. But those agreements still control how you get paid today. If your contracts haven’t been reviewed in a few years, chances are you’re due for a serious update. Outdated terms and […]
Contract Negotiation Secrets for Providers Read More »
The healthcare industry is facing a significant crisis: a shortage of providers. This shortage has far-reaching effects, not just on patient care but also on the financial health of healthcare organizations. From delayed revenue to overworked staff, the ripple effects of fewer providers are being felt across the board. Here’s why it’s more than just
Provider Shortages: A Crisis Impacting Revenue & Patient Access Read More »
Behavioral health revenue cycle management (RCM) has many unique challenges that can significantly impact cash flow and operational efficiency. There are several levels of care, including outpatient treatment, detox services, intensive outpatient programs (IOP), partial hospitalization programs (PHP), and residential treatment facilities (RTF). Managing the behavioral health revenue cycle needs more than a standard approach.
Unraveling the RCM Maze in Behavioral Health Read More »
Reforming Prior Auth: A Turning PointSeen by many as crucial to efficient healthcare delivery and timely reimbursement, prior authorization reform is gaining momentum—and providers need to be ready. Will 2025 Be the Year We Fix the Prior Authorization Delays? In the ever-evolving world of healthcare reimbursement, prior authorization delays have become one of the most
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Denied claims can be a major roadblock in the revenue cycle processes of any healthcare organization. In a 2024 report, 38% of survey respondents said at least one in ten claims is denied. It is not unusual for an organization to see claims denied more than 15% of the time! Why does this matter? Well,
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Navigating 2025 Reimbursement Changes: What Providers Need to Know As most of you are probably aware, Medicare has implemented several changes affecting specialists’ reimbursement, primarily through adjustments to the Medicare Physician Fee Schedule (MPFS). The Centers for Medicare & Medicaid Services (CMS) have released a conversion factor of $32.35 for the calendar year (CY) 2025,
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