Insights
How the revenue cycle actually behaves
Plain explanations of the mechanics that decide whether a practice gets paid — denial codes, filing deadlines, credentialing timelines and the numbers worth tracking. No statistics we cannot source, no case studies we cannot name.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
8 guides
Start with the question you have
The denial codes that cost practices the most
What CO-16, CO-18, CO-45, CO-97, CO-109, CO-197 and PR-204 actually mean, why each one fires, and what has to change upstream so it stops repeating.
( Explainer )Clean claim rate, and why first-pass acceptance is the number to watch
How clean claim rate and first-pass resolution are calculated, why the two differ, and the upstream steps that actually move them.
( Explainer )Days in A/R — how it is calculated and what actually moves it
The days in accounts receivable formula, why the aging buckets matter more than the headline number, and the specific causes behind a rising A/R.
( Timeline )How long provider credentialing takes, and what makes it take longer
The credentialing and payer enrolment sequence — CAQH, NPI, primary source verification, contracting — and the specific things that stall it.
( Decision guide )Outsourced or in-house billing — how to actually decide
A decision framework for outsourcing medical billing: the real cost comparison, the control questions, key-person risk, and when in-house is the better answer.
( Explainer )Prior authorization — what triggers it and how practices lose money on it
Why prior authorization denials are unappealable after the fact, what triggers a requirement, and the workflow that prevents CO-197 from recurring.
( Reference )Timely filing limits — the deadline that turns receivables into write-offs
How timely filing limits work, why the appeal clock is separate and shorter, what proof of timely filing means, and how claims quietly age past the deadline.
( Checklist )Switching billing companies without losing your A/R
What to settle before changing billing vendors: who works the legacy A/R, EDI and ERA re-enrolment, and the overlap that prevents a collections gap.
Denials & A/R
Money already earned, sitting unpaid
Denials and aged receivables are the two places a practice most often loses revenue it has already delivered the care for.
( 1 )
Read denials as patterns, not tickets
Grouping by CARC and RARC turns a queue into a handful of fixable upstream failures.
( 2 )
Sort A/R by deadline, not by age
Inside any aging report is a subset approaching a filing or appeal limit. That subset is recoverable now and unrecoverable later.
( 3 )
Measure first-pass resolution, not just acceptance
A claim can clear the clearinghouse and still be wrong. Clean claim rate hides that; first-pass resolution does not.
Credentialing & authorisation
The failures that happen before the claim exists
Prior authorisation and credentialing denials cannot be worked after the fact. They are prevented at scheduling, or they are written off.
( 1 )
Authorisation is set per plan, not per payer
Two patients with the same carrier can have different requirements. Carrier-level habit is what produces CO-197.
( 2 )
Approval is not an effective date
A provider is billable when the contract is executed and the effective date arrives, not when the committee approves.
( 3 )
Re-credentialing lapses are silent
A missed deadline terminates participation, and claims begin denying as out of network for a provider whose situation has not changed.
Choosing a biller
Questions worth asking before you sign anything
Including the ones that are awkward to ask us.
( 1 )
Whose systems does the work happen in?
If billing runs inside your practice management system under credentials you control, you keep visibility and there is no exit cost.
( 2 )
Who works the legacy A/R, and until when?
There is no default answer. Unsettled, this is where balances quietly age past their deadlines during a transition.
( 3 )
What happens when one person leaves?
Ask it of your current arrangement as well. Key-person risk is the most under-weighted factor in a small billing department.
Next step
Rather just ask someone?
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.