You pull the monthly aging run, sort descending by balance, and your eye goes straight to the oldest bucket. That reaction is normal. It's also where a lot of billing teams lose the plot. In specialty practices,
You pull the monthly aging run, sort descending by balance, and your eye goes straight to the oldest bucket. That reaction is normal. It's also where a lot of billing teams lose the plot. In specialty practices,
A denied claim can look like a small administrative interruption, but the scale tells a different story. In U.S. healthcare billing, denial rates reached 11.8% in 2024, compared with 10.2% in 2020, and initially denied claims have
The American Hospital Association reported that Medicare and Medicaid underpayments totaled $100.4 billion in 2020, up from $75.8 billion in 2019. Medicare payments covered only 84 cents per dollar of hospital cost, while Medicaid covered 88 cents,
A clean claim arrives with the right diagnosis, the right modifiers, and complete documentation. The payer processes it, but the payment lands below the contracted amount. Nobody can immediately say whether the cause was an outdated fee
More than 1.46 million disputes were initiated under the No Surprises Act independent dispute resolution process in 2024, more than double the prior year's volume and more than seven times the 2022 level, according to the Congressional
The most dangerous timely filing denial is often attached to a claim that was coded correctly, medically necessary, and fully covered. A claim can still become uncollectible because the payer received it after its filing window closed.
Hospitals lose about 3% to 5% of net revenue every year through revenue leakage. In healthcare, revenue leakage is earned but uncollected revenue caused by denials, underpayments, eligibility gaps, coding failures, and contract variance. That loss is
Healthcare claim denial rates rose from 10.15% in 2020 to 11.81% in 2024, according to industry reporting summarized in the Optum 2024 Revenue Cycle Denials Index. That shift changes the accounts receivable management problem. Specialty practices aren't
The first clue usually shows up months late. A payer remits a claim as paid in full, the posting team closes it, and only after a contract review or an IDR packet does the underpayment surface, buried
You're probably living the same mess right now, a new provider has been hired, the welcome email went out, the roster looks “done,” and then weeks later claims start stalling because enrollment never caught up with credentialing.
