Practical insights on denial management, payer underpayments, coding optimization, and revenue recovery — written by someone who's been doing this for 20+ years.
Most practices assume payers pay what they've contracted to pay. They're wrong. Systematic underpayment — even 10–15% below contracted rates — can cost a mid-size practice $40,000–$80,000 per year in lost revenue. Here's how to find it.
Systematic underpayment baked into allowed amounts can cost a practice $40K–$80K per year. Here's how to find it using your own EOB data.
After auditing hundreds of practices, we see the same five denial patterns over and over. Here's what they are, why they happen, and exactly how to fix them.
The difference between 99213 and 99214 is $35–$45 per visit. If you're seeing 40 patients a day and undercoding 30% of them, that's over $150,000 per year walking out the door.
Missing modifier 25 on same-day E&M and procedure claims is the single most common source of preventable denials. Here's the complete guide.
Most practices sign payer contracts and never renegotiate. After 3–5 years, those rates are often 20–30% below what the same payer is offering new entrants.
A surprising number of practices never file secondary claims for dual-coverage patients. Here's how to identify them and how much you're likely leaving uncollected.
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