Insights & Resources
Practical guidance on revenue cycle, coding, compliance, and the business of healthcare.
A strong collection rate doesn’t always mean your practice is capturing all the revenue it has earned. Missed charges, undercoding, payer underpayments, preventable denials, and hidden write-offs can quietly create revenue leakage, even when your billing reports look healthy. Learn what practice owners should be looking at beyond collections to uncover where revenue may be slipping through the cracks.
An aging report tells you how much is outstanding and how old it is. It rarely tells you why the money is still sitting there — and the claim that never entered the system does not appear at all.
One orthopedic patient can generate an office visit, X-rays, an injection, a brace, fracture care, and surgery — all for the same condition. The costly errors are rarely the obscure rules; they are the everyday ones a practice repeats hundreds of times.
Ask five people when critical care is billable and you will hear five answers. It is not the ICU, not the ventilator, and not a severe-sounding diagnosis — it is the patient's risk, the physician's work, and the qualifying time.
A global period is not a 10- or 90-day "do not bill" window, and it is not a free pass to add a modifier either. Here is what the surgical package actually covers, what it does not, and the six questions that settle any encounter.
"We can't bill it — the patient is still in the global." Sometimes that's right. Sometimes it hands away a medically necessary service that was never part of the surgery. Here's when Modifier 24 applies — and when it doesn't.
The consult isn't dead — but it depends on who's paying. Medicare stopped recognizing consultation codes in 2010; many commercial payers never followed. Billing every payer the same way costs practices money in both directions.
"I assumed prior authorization had been obtained." "I assumed the provider was credentialed." The assumptions that quietly delay payments, drive denials, and cost practices hundreds of thousands of dollars — and the verification habits that replace them.
Small modifier. Big consequences. Every month we review thousands of physician claims, and the same ten modifier mistakes keep surfacing — driving denials, underpayments, and audit risk. Here is what to watch for.
