Vaccine Revenue Leakage in Pediatric Practices: Finding the Gaps Between Administration, Inventory and Payment
A vaccine can be administered correctly, documented correctly, and still create a revenue-cycle problem. When inventory, eligibility, coding, NDC data, and payer requirements don't stay connected, leakage can hide in places traditional A/R reporting never sees. Here's a closer look at the overlooked gaps in pediatric vaccine billing—and what practices can do to make them visible.
Medicare Compliance: Why the Right Modifier Starts Before the Claim
Medicare compliance doesn’t begin when a claim reaches the billing queue. From identifying potential coverage issues and managing ABNs to selecting the right modifiers and preserving supporting documentation, every step in the workflow can influence what happens next. This article explores how GA, GX, GY, and GZ fit into the larger Medicare compliance picture—and why stronger processes upstream can help practices prevent avoidable billing and compliance issues downstream.
Timely Filing: The Revenue Cycle Deadline That Starts Before Billing
Timely filing denials rarely begin at the billing desk. By the time a claim misses its filing deadline, the real problem may have started much earlier—with delayed documentation, coding backlogs, unbilled charges, or a rejection that left too little time for correction. This article explores how seemingly small upstream delays can quietly erode the filing window and why treating timely filing as an end-to-end revenue cycle metric can help organizations identify risk before it becomes a denial.
The Orthopedic Revenue Checklist: 10 Areas That Deserve a Closer Look
Orthopedic revenue leakage doesn't always begin with a denied claim. It can start much earlier—with missed charges, authorization delays, documentation gaps, coding issues, or disconnected workflows that quietly affect reimbursement. This article takes a closer look at 10 critical areas across the orthopedic revenue cycle and explores how practices can move from reactive revenue recovery to proactive revenue protection.
AHCA Audits for Florida Practices: Is Your Practice Really Audit-Ready?
An AHCA audit shouldn't be the first time a Florida practice examines whether its Medicaid claims are defensible. From documentation and coding to provider enrollment, claims data, and internal controls, audit readiness is built into the revenue cycle long before an auditor comes knocking. This article explores what Florida Medicaid practices should be watching—and how a proactive, risk-based approach can turn audit preparation from a last-minute scramble into an ongoing compliance discipline.