A 100% increase in clinical documentation audits, combined with final denial-dollar increases of 34% for professional claims, 84% for hospital outpatient claims, and 148% for hospital inpatient claims, has changed the financial role of the medical record.
In a 2026 report, IDR awards exceeded the qualified payment amount in 87% of determinations over a six-month period, according to HFMA's reporting on No Surprises Act IDR data. That result changes how revenue cycle teams should
The denial hit the inbox, the EOBs are stacked on the desk, and somebody in the billing office is already asking whether this one is worth fighting. That's the right moment to slow down, because most appeals
Out-of-network billing isn't just a patient complaint problem anymore. In a major national study published in JAMA Internal Medicine, the share of emergency department visits with at least one out-of-network bill rose from 32.3% in 2010 to
Out-of-network means the doctor, hospital, or other provider doesn't have a contract with the patient's insurance plan, so there's no pre-negotiated rate in place. In practical terms, that changes both pricing and patient liability, and it's why
