Denied claims drain up to 10% of a private practice’s annual net revenue. We examine the five most pervasive denial codes (CO-4, CO-16, CO-18, CO-22, and CO-97), root-cause prevention mechanisms, and structured appeal tactics that overturn rejections.
The latest CMS ICD-10 code set adds new categories affecting behavioral health, social determinants of health (Z-codes), and primary care preventive tracking.
Small practices often overlook basic ePHI safeguards, Business Associate Agreements (BAAs), and encrypted communication protocols. Here is what HHS auditors look for.
Days in A/R is the supreme vital sign of your revenue cycle. Learn how to calculate gross vs. net days in A/R and isolate aging payer bottlenecks.
Federal interoperability and prior authorization mandates require payers to implement electronic APIs and shorten approval timeframes. Here is how your clinic can prepare.
Psychiatric diagnostic evaluations (90791) and time-based psychotherapy codes (90837) face intense payer scrutiny. Learn the documentation rules that safeguard reimbursement.
Avoid costly Medicare takebacks by correctly applying the 8-minute rule, documenting timed therapy increments (97110, 97140), and tracking the annual KX modifier therapy cap.
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