Revenue cycle learning center

How to improve your clean claim rate

You improve your clean claim rate by fixing errors before the claim leaves the office: verified eligibility and demographics, accurate codes and modifiers, a claim scrubber with payer-specific edits, and correct provider enrollment data.

A/R

How to reduce accounts receivable in a medical practice

To reduce accounts receivable, measure days in A/R and the share over 90 days, then work open claims by payer and aging bucket with the largest and most time-sensitive balances first.

Practice Management

Read the guide 9 min read

In-house vs. outsourced medical billing: which fits your practice?

In-house billing works best for practices with enough volume to support a trained team and a billing manager, while outsourcing usually fits small practices with one biller, rising A/R or growing denials.

How to switch medical billing companies in 10 steps

To switch medical billing companies, review your current contract and data, split open A/R between the old and new vendor, confirm credentialing, set up your EHR, clearinghouse and ERA enrollments for the new team, map workflows, tell your staff, then manage the run-out and watch the first 90 days closely.

What to look for in a medical billing company: a practical checklist

Look for a medical billing company that signs a Business Associate Agreement, reports clearly every month, has experience in your specialty, works inside your current EHR, prices in a way you can predict, and offers fair contract terms.

Medical billing company vs. RCM partner: what each does and which one fits your practice

A medical billing company works the claim once the visit is done: charge entry, submission, posting and follow-up.

Reduce revenue loss in your practice: 10 common leaks and how to plug them

Small practices most often lose revenue through unverified eligibility, missed charges, undercoding, modifier errors, unworked denials, missed filing deadlines, underpayments, low fee schedules, uncollected patient balances and enrollment gaps.

Outsourcing RCM: when it makes sense for a small practice and how to choose a partner

Outsourcing RCM makes sense for a small practice when billing depends on one person, denials and old A/R are growing, or the practice is adding providers faster than staff can keep up.

Compliance

Medical billing audit checklist: what to review and what to look for

A medical billing audit checks whether each visit was registered, coded, billed, paid and followed up correctly.

Medical Billing

Read the guide 9 min read

Medical billing vs. revenue cycle management: what is the difference?

Medical billing is the claim stage: turning a visit into a claim, submitting it, posting the payment and following up until it is paid.

How does medical billing work? The revenue cycle step by step

Medical billing turns a patient visit into payment: the practice verifies insurance, documents and codes the visit, sends a claim to the payer through a clearinghouse, posts the payer's payment and adjustments, and bills the patient for what remains.

Read the guide 7 min read

How much do medical billing companies charge?

Most medical billing companies charge a percentage of monthly collections, usually between 4% and 9%, with small or complex practices often quoted higher.

Accurate medical billing for faster reimbursement

Reimbursement slows down when claims go out late, eligibility is not verified, coding trips payer edits, rejections go unworked or payments arrive on paper.

Medical Coding

Modifier 25 billing guide: when to use it and how to document it

Modifier 25 goes on an E/M code when the same provider performs a significant, separately identifiable E/M service on the same day as a procedure or other service.

Denial Management

Timely filing limits by payer: what practices need to know in 2026

Medicare requires claims to be filed within 12 months (one calendar year) of the date of service.

Why are medical claims denied? The top causes and how to prevent them

Medical claims are denied mostly for preventable reasons: inactive coverage, missing authorizations, incomplete claim data, coding and modifier errors, bundling edits, medical necessity mismatches, duplicates and late filing.

Common claim denial reasons and how to fix them

The most common claim denials come from eligibility errors, missing information, missing prior authorization, medical necessity or coding mismatches, bundling edits, duplicates and missed filing deadlines.

AI in Revenue Cycle

AI-powered RCM vs. traditional medical billing: what AI does today and where people still decide

In revenue cycle management, AI tools today mostly handle high-volume checking and sorting: running 270/271 eligibility checks, scrubbing claims against NCCI and payer edits, categorizing denials by CARC and RARC, ranking A/R work and matching 835 payments to expected amounts.

Medicare

Incident-to billing for nurse practitioners explained

Incident-to billing lets a nurse practitioner's follow-up service be billed to Medicare under the supervising physician's NPI at 100% of the fee schedule instead of 85%.

Credentialing

How long does provider credentialing take?

Provider credentialing usually takes 90 to 120 days with commercial payers once the application is complete, while Medicare enrollment often takes about 45 to 60 days.