Healthcare regulatory updates arrive with clockwork regularity, each bringing new requirements that practices must decode and implement. Rather than getting lost in bureaucratic language, medical practices need clear guidance on what these changes mean for daily operations, revenue cycles, and patient care. Each section provides actionable strategies practices can deploy immediately to ensure compliance while […]
CMS Fee Schedule, Contract Negotiation, Contracting, Contracting Fee Schedule, Decoding Payment Changes, Healthcare Policy, Healthcare Regulatory Changes, No Surprises Act
Staying on top of enrollment requirements is essential for keeping a medical practice running smoothly. PECOS has become the backbone of Medicare enrollment, replacing outdated paper processes with a streamlined digital system. Beyond just being a requirement, PECOS offers real advantages that can save you time, reduce headaches, and protect your practice. Below, we document […]
Centers for Medicare & Medicaid Services, CMS, Medicare, Medicare Billing, Medicare Credentialing, Medicare Enrollment, Medicare In-Network, Medicare PECOS, Medicare Reimbursement, PECOS, PECOS 2.0
You’re sitting at your desk, staring at another credentialing application that’s weeks overdue. Your office manager is juggling three other urgent tasks. Your new physician is frustrated because they still can’t see patients. And you’re wondering… is there a better way to handle this? The answer might surprise you. After 25+ years in medical credentialing, […]
Cost-Benefit Analysis, Credentialing Cost-Benefit Analysis, In-House Credentialing, In-House vs Outsourced Credentialing, Medical Credentialing, Outsourced Credentialing, Outsourced Credentialing Value
Most medical providers accept the first insurance contract they’re offered without realizing how much money they’re leaving on the table. Payer contracting creates direct value for your practice by securing better reimbursement rates, clearer payment terms, and favorable contract language that protects your financial interests. Let’s explore how strategic payer contracting delivers tangible value to […]
Contract Analysis, Contract Management, Contract Negotiations, Contracting, Data-Driven, Data-Driven Negotiations, Healthcare Rate Negotiations, Medical Rate Negotiations, Payer Contract Analysis, Payer Contract Negotiation, Payer Contracting, Payer Contracting Value, Payer Contracts, Payor Contracting, Rate Negotiations
Medical credentialing can make or break a practice’s ability to serve patients and collect payments. The right workflow streamlines the entire process, cutting approval times from months to weeks while reducing errors that cause frustrating delays. Let’s explore the best credentialing workflows and how to implement them in your practice. What Makes a Credentialing Workflow […]
Credentialing, Credentialing Automation, Credentialing KPIs, Credentialing Optimization, Credentialing Software, Credentialing Strategies, Credentialing Technology, Credentialing Tips, Credentialing Workflows, Medical Billing
Medical billing involves tracking claims through multiple stages, from submission to final payment. Two essential tools help practices monitor this process: Electronic Remittance Advice (ERAs) and real-time claim status checks. While both provide information about claim status, they serve entirely different purposes and deliver different types of data at different points in the revenue cycle. […]
Claim Adjustment Reason Codes, Claim Check, Claim Status Check, EFT, Electronic Funds Transfer, EOBs, EOPs, ERAs, Real-Time Claim Status Check, Remittance Advice Remark Codes, Transaction Enrollment
Modifiers can make or break your practice’s revenue cycle. Among all the modifiers in the CPT coding system, Modifier 59 stands out as one of the most important and most frequently misused. This two-digit code can mean the difference between getting paid for the services you provide and watching claims get denied or downcoded. Modifier […]
Articles, CMS, Coding, Healthcare, Healthcare Billing, Medical, Medical Billing, Medicare Modifiers, Modifier 59, Modifier Code, Modifier XE, Modifier XP, Modifier XS, Modifier Xu, Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
The 2026 CPT coding updates are here, and they’re bringing significant changes that will directly impact your practice’s revenue cycle. Whether you’re billing for primary care, specialty services, or diagnostic procedures, these updates require your immediate attention. Ignoring them or implementing them incorrectly will result in claim denials, payment delays, and frustrated staff members trying […]
99421, 99423, 99441, 99443, 99453, 99454, 99457, 99458, CPT 99453, CPT 99454, CPT 99457, CPT 99458, G2012, G2252, MDM, MDM Coding, Medical Coding, Modifier 25, Modifier 59, RPM Codes, Telehealth Codes, Telemedicine Codes
Financial performance serves as the backbone of any thriving healthcare organization. For medical practices across the country, knowing how much revenue flows in with each patient visit reveals critical insights about overall financial health. Among all the metrics that matter in revenue cycle management, Average Revenue Per Encounter (ARE) stands out as one of the […]
ARE, Average Revenue Per Encounter, Average Revenue Per Encounter (ARE), Average Revenue Per Patient Encounter, Medical Billing, Medical Billing and Coding, Payer Mix
The Merit-Based Incentive Payment System (MIPS) represents a critical component of healthcare’s value-based payment system, directly impacting your practice’s Medicare reimbursements. Yet many healthcare providers find themselves leaving money on the table due to suboptimal MIPS strategies. Knowledge of how to optimize your performance across all four MIPS categories can mean the difference between payment […]
Cost Category, Improvement Activities, Improvement Activities Category, Merit-Based Incentive Payment System, MIPS, MIPS Optimization, Promoting Interoperability, Promoting Interoperability Category, Quality Category
Signing a contract with an insurance company feels like a victory. You’ve negotiated rates, agreed to terms, gotten credentialed, and can finally start billing for services. Many healthcare providers treat contract signing as the finish line, filing the agreement away and moving on to see patients. But that’s where a critical mistake happens. The real […]
Contract Analysis, Healthcare Rate Negotiations, Payer Contracting, Payer Contracts, Payer Negotiations, Payer Relations, Post-Contract, Post-Contract Performance Monitoring, Proactive Rate Negotiations, Rate Negotiations
Allied health professionals form the backbone of modern healthcare delivery, yet their credentialing needs often get overlooked or mishandled. Physical therapists, occupational therapists, speech-language pathologists, dietitians, respiratory therapists, and dozens of other allied health providers face unique credentialing challenges that differ significantly from physician credentialing. Getting these professionals credentialed correctly and efficiently requires specialized knowledge […]
Allied Health, Allied Health Credentialing, Articles, Credentialing, Occupational Therapy Credentialing, OT Credentialing, Physical Therapy Credentialing, PT Credentialing, SLP Credentialing, Speech Therapy Credentialing
Provider credentialing can feel like learning a new language when you first encounter it. The terminology, timelines, and requirements seem designed to confuse rather than clarify. Credentialing is just a systematic process of verifying that healthcare providers have the qualifications they claim and getting them approved to bill insurance companies. Once you know the steps, […]
Credential Maintenance, Credentialing, Credentialing Committee, Credentialing Difficulty, Credentialing Documentation, Credentialing Management, Credentialing Mistakes, Credentialing Timelines, Credentialing Tips
If you’re a healthcare provider looking to expand your practice and serve more patients, getting credentialed with Medicare is essential. Medicare provides health coverage to over 65 million Americans, including people aged 65 and older, younger individuals with disabilities, and people with End-Stage Renal Disease. By becoming a credentialed Medicare provider, you open your doors […]
Credentialing, Credentialing Accuracy, Credentialing Approval, Credentialing Criteria, Credentialing Documentation, Credentialing KPIs, Credentialing Management, Credentialing Optimization, Medicare, Medicare Credentialing
Medical credentialing isn’t a one-size-fits-all process. Every practice situation brings its own set of challenges, timelines, and requirements that can catch you off guard if you’re not prepared. Whether you’re hiring your first provider, opening a new location, adding telehealth services, or managing a practice merger, each scenario demands specific knowledge and careful planning. We’ve […]
Credentialing, Credentialing New Providers, credentialing on-boarding, Credentialing Optimization, Credentialing Pitfalls, Credentialing Problems, credentialing process, Credentialing Services, Credentialing Solutions, Credentialing Use Cases
Moving your medical practice to a new location sounds exciting until you hit the credentialing reality. Whether you’re shifting to a new state, opening a second office across town, or expanding into border regions, the credentialing process can feel like starting from scratch. Honestly…? Sometimes it is. Let’s talk about what actually happens when you […]
Credential Maintenance, Credentialing, Credentialing Applications, credentialing challenges, Credentialing Difficulty, Credentialing Optimization, Credentialing Pitfalls, Credentialing Problems, Relocation Credentialing
Medical billing continues to shift at a rapid pace, and 2026 promises to bring changes that will reshape how healthcare organizations manage their revenue cycles. From artificial intelligence taking on more administrative tasks to new payment models gaining traction, the trends emerging this year will impact everyone from solo practitioners to large hospital systems. If […]
AI, Articles, Artificial Intelligence, Automated Billing, Automation, Billing, Billing Automation, Blockchain, Blockchain in Healthcare, Blockchain Technology, Cybersecurity, Data Interoperability, FHIR, Health Level 7, HL7, Machine Learning, Value Based Care, Value-Based
If you’re a healthcare provider looking to expand your practice and serve more patients, getting credentialed with Medicaid is a smart move. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. By becoming a credentialed Medicaid provider, you open your doors to a […]
Credentialing, Credentialing Accuracy, Credentialing Approval, Credentialing Criteria, Credentialing Documentation, Credentialing KPIs, Credentialing Management, Credentialing Optimization, Medicaid, Medicaid Credentialing
Every healthcare organization faces the same frustrating problem. You recruit a talented physician, negotiate a great contract, and set a start date. Then credentialing begins, and suddenly everything crawls to a halt. Weeks turn into months. The provider sits idle, unable to see patients. Revenue that should be flowing in never materializes. This scenario plays […]
Credentialing, Credentialing Bottlenecks, Credentialing Delays, Credentialing Denials, Credentialing Difficulty, Credentialing Errors, Credentialing Gap, Credentialing Pitfalls, Credentialing Problems, Credentialing Red Flags
Small details can make or break your revenue cycle. One of the most common areas where practices struggle is deciding whether to bill under a Group NPI or an Individual NPI. Getting this wrong doesn’t just delay payments. It can trigger claim denials, compliance issues, and audit flags that hurt your bottom line. The National […]
CMS-1500, Group NPI, Individual NPI, Medicaid, Medicaid Billing, Medicare, Medicare Billing, National Provider Identifier, NPI, NPPES, Private Insurance, Provider NPI, PTAN
Revenue cycle management stands as one of the most critical operational functions for any business that depends on consistent cash flow. Whether you’re running a medical practice, managing a subscription service, or operating a professional services firm, the way you handle revenue generation from initial customer contact through final payment collection can make or break […]
RCM, RCM Automation, RCM Challenges, RCM Data Analytics, RCM Metrics, RCM Optimization, RCM Outsourced, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management (RCM), Revenue Cycle Management Challenges
Provider credentialing serves as a fundamental quality assurance process in healthcare, ensuring patients receive care from qualified medical professionals. For healthcare providers seeking to join PacificSource’s network, mastering the credentialing process opens doors to serving one of the Pacific Northwest’s most established health insurance organizations. PacificSource operates as a not-for-profit health insurer serving Oregon, Washington, […]
CAQH, CAQH ProView, Credentialing, Credentialing Approval, Credentialing Cycle Time, Credentialing Regions, Credentialing Services, Medical Credentialing, PacificSource, PacificSource Credentialing
Getting credentialed with insurance companies should be straightforward, but for many healthcare providers, it turns into a months-long headache. You’ve spent years earning your medical degree, completing residencies, and building your practice. Yet somehow, filling out insurance forms becomes one of the most frustrating parts of starting or expanding your healthcare business. The credentialing process […]
Credentialing, credentialing challenges, Credentialing Delays, Credentialing Denials, Credentialing Difficulty, Credentialing Management, Credentialing Optimization, Credentialing Pitfalls, Credentialing Problems
The healthcare billing world is about to shift in 2026, and if you’re a provider, practice manager, or billing professional, you need to know what’s coming. The Centers for Medicare & Medicaid Services (CMS) has rolled out new rules for Evaluation and Management (E/M) services and telehealth that will affect how you document visits, code […]
Alternative Payment Models, APM, APMs, E/M, MDM, MDM Coding, Medical Decision-Making, Physician Fee Schedule, Reimbursement Models, Reimbursement Optimization, Reimbursement Rates, Time-Based Coding
In medical credentialing, few aspects are as crucial (or as potentially confusing) as securing proper professional and peer references. Whether you’re a newly minted physician applying for your first hospital privileges or an experienced practitioner seeking credentialing at a new facility, knowledge of who can serve as references and what information they need to provide […]
Credentialing, Credentialing Applications, Credentialing Cycle Time, Credentialing Delays, Credentialing New Providers, credentialing on-boarding, Credentialing Pitfalls, Medical Credentialing, Peer Reference, Professional Reference