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RCM Performance, AI-Enabled Controls, and Predictable Revenue
Articles and insights on RCM performance, AI-enabled controls, and building predictable revenue outcomes.
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September 9, 2026
Healthcare RCM Metrics: 10 Key KPIs to Monitor
The 10 key RCM metrics are clean claim rate, days in A/R, claim denial rate, net collection rate, gross collection rate, A/R over 90 days, first-pass resolution rate, payment turnaround time, cost to collect, and revenue…
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September 8, 2026
Insurance Coverage Changes That Cause Preventable Claim Denials
Insurance often changes between the day an appointment is scheduled and the day of service, through job changes, plan renewals, or Medicaid redeterminations. If eligibility isn't rechecked close to the visit, claims go t…
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September 7, 2026
Eligibility Exception Workflows: Resolving Coverage Discrepancies
An eligibility exception is any coverage mismatch found during verification, such as an inactive plan, wrong payer, or changed member ID. Exception workflows route these cases to someone who resolves them before the clai…
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September 4, 2026
EHR Go-Live Revenue Risk: What Healthcare Organizations Should Monitor After Implementation
An EHR can go live on schedule and still disrupt revenue. In the weeks after launch, monitor claim volume, charge capture, coding and documentation changes, clearinghouse and payer connections, payer mapping, and registr…
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September 3, 2026
How to Identify Which Legacy A/R Balances Are Still Worth Pursuing
A legacy A/R balance is worth pursuing when it's still within the appeal or filing window, the dispute can be resolved with available documentation, the payer or patient can realistically pay, and the recovery value exce…
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September 1, 2026
Payer Mapping Errors: How Incorrect Payer IDs Cause Electronic Claim Rejections
A payer ID tells the clearinghouse where to route an electronic claim. If the practice management system maps a plan to the wrong payer ID, claims are rejected or sent to the wrong payer, often without anyone noticing. A…
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August 28, 2026
Credentialing Status Tracking: What Revenue Cycle Leaders Should Monitor
Revenue cycle leaders should track credentialing as a financial risk, not paperwork. Key metrics include time from application to approval, applications pending by payer, upcoming recredentialing deadlines, and providers…
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August 25, 2026
Agentic AI Healthcare Revenue Cycle: What's Actually Real in 2026
In 2026, agentic AI is delivering real results on narrow, rules-heavy revenue cycle tasks, while fully autonomous billing, coding, and denial resolution is still mostly a vendor promise. The practical test is whether a t…
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August 21, 2026
What Is Medical Coding? A Complete Guide
Medical coding translates diagnoses, procedures, and services from clinical documentation into standardized codes that payers use to process claims. The main code sets are ICD-10-CM for diagnoses, CPT for procedures, and…
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August 18, 2026
Medical Billing vs. Medical Coding: What's the Difference?
Medical coding translates clinical documentation into standardized codes (ICD-10-CM, CPT, and HCPCS). Medical billing uses those codes to create claims, submit them to payers, and follow up until payment. Coding determin…
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