Category: Revenue Cycle Management

How a Medicare Out-of-Pocket Cap Could Reshape Healthcare

For millions of Americans relying on Medicare, the specter of high out-of-pocket healthcare costs looms large. Unexpected illnesses, chronic conditions, and even routine medical needs can quickly erode savings and create significant financial strain. The idea of a Medicare out-of-pocket spending cap has long been a topic of discussion, promising a shield against catastrophic expenses. […]
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Medical billing compliance

How Medical Billing Compliance Can Protect Your Medical Practice

In today’s evolving healthcare environment, medical billing compliance is more than just a legal requirement—it’s a strategic safeguard for your medical practice. As regulations tighten and audits become more frequent, staying compliant with medical billing standards helps protect your practice from costly fines, revenue losses, and reputational damage. What Is Medical Billing Compliance? Medical billing […]
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MIPS Penalties

MIPS Penalties Hit Small Practices Harder – RCM Solutions Key

When it comes to the Merit-based Incentive Payment System (MIPS), 2025 data reveals a striking disparity: small and rural medical practices were disproportionately penalized, facing significantly higher penalties than their larger, urban counterparts. While the vast majority of MIPS-eligible clinicians (86%) successfully avoided penalties this year, based on their 2023 data, those who did incur […]
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failing on prior auth reform

Health Insurance Industry Is Failing on Prior Authorization Reform

In theory, prior authorization (PA) exists to ensure that healthcare services are medically necessary and cost-effective. But in practice, it has become a bureaucratic roadblock causing treatment delays, administrative overload, and provider burnout. Despite increasing pressure from physicians, hospitals, patient advocacy groups, and even bipartisan lawmakers, the health insurance industry failing on prior authorization reform […]
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Healthcare Data Breach Notifications

Healthcare Data Breach Notifications for Patients: What You Need to Know

In today’s digital age, patient health information (PHI) is increasingly stored and managed electronically. While this shift improves efficiency and accessibility in healthcare, it also introduces significant data privacy and security challenges. One critical area of concern is healthcare data breach—incidents where patient data is accessed, disclosed, or stolen without authorization. Under the Health Insurance […]
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Denial Prevention vs. Denial Facilitation

Denial Prevention vs. Facilitation: Optimize Healthcare Revenue

In the healthcare revenue cycle, denials are inevitable — but how you manage them makes all the difference. A common discussion in this space centers around Denial Prevention vs. Denial Facilitation, two strategies that, while they may sound similar, have distinct purposes and outcomes. Understanding and effectively applying both can drastically improve your practice’s cash […]
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Medicare Advantage plans benefit

Medicare Advantage Plans Benefit from Expert Medical Billing

As the U.S. healthcare system continues to evolve, Medicare Advantage (MA) plans have seen rapid growth, offering seniors an alternative to traditional Medicare. With more than 30 million beneficiaries enrolled in Medicare Advantage as of 2025, the demand for administrative efficiency and accurate claims processing has never been greater. Medical billing companies play a pivotal […]
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