Three Medicaid Changes Land in January
Three Medicaid Changes Land on January. Your Eligibility Workflow May Not Be Ready for Them. Most of the conversation about the One Big Beautiful Bill Act has been about coverage. That is the right conversation to have, but it is not the only one. For practices that see a meaningful volume of Medicaid patients, three […]
Boutique RCM vs. Big-Box Billing: What Specialty Practices Actually Need
Boutique RCM vs. Big-Box Billing: What Specialty Practices Actually Need Outsourced revenue cycle management is no longer a niche decision. Industry research shows the outsourced RCM market is on pace to nearly double within four years, and roughly 70% of hospitals and health systems plan to expand their RCM outsourcing engagements. Rising denial rates, staffing […]
The New CMS Prior Authorization Rules Are Here. So Why Are Denials Still Rising?
The New CMS Prior Authorization Rules Are Here. So Why Are Denials Still Rising? On January 1, 2026, the most significant federal prior authorization reform in over a decade took effect. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) was designed to reduce the friction that costs practices billions in delayed and denied care […]
The Modifier 25 Cut Is Paused. The Audit Wave Isn’t.
BCBS Michigan’s 50% Modifier 25 reimbursement cut is paused, but the audit wave isn’t. Here’s what every practice billing same-day E/M and procedures needs to do now.
Denial Prevention vs. Denial Management: Why the Difference Costs You Real Money
Claim denial rates keep climbing in 2026. Learn why denial prevention beats denial management, and how to stop revenue leakage before claims are ever submitted.