The American Medical Association (AMA) and nearly 100 other organizations are backing legislation that aims to force payers to comply with independent dispute resolution (IDR) payment determination rules. This unified action comes amid ongoing reports from providers about nonpayment, delayed payment, and improper billing practices by payers. Healthcare providers are now asking lawmakers to put […]
That sinking feeling when an unexpected, sky-high medical bill lands in your mailbox – it’s a universal experience for many. Welcome to the world of “surprise medical billing,” a frustrating byproduct of our complex healthcare system. Thankfully, new federal protections are in place to shield consumers. But what happens when a surprise bill still sneaks […]
Revenue cycle management (RCM) is the financial backbone of any medical practice, ensuring timely reimbursement while maintaining compliance with ever-evolving regulations. However, many practices unknowingly face significant compliance risks that can lead to claim denials, audits, financial penalties, and even legal consequences. Common pitfalls include billing and coding errors, fraud and abuse violations, HIPAA breaches, […]
The medical billing landscape is evolving rapidly, driven by advancements in technology, regulatory updates, and shifting patient expectations. Staying informed about Top Medical Billing Trends is crucial. As we enter 2025, healthcare providers and medical billing companies must stay ahead of the curve to ensure compliance, maximize revenue, and improve patient satisfaction. This newsletter will […]
As the healthcare landscape continues to evolve at an unprecedented pace, 2025 is poised to be a landmark year for revenue cycle management (RCM). With regulatory changes, emerging technologies, and shifting patient expectations, healthcare providers and RCM professionals must stay ahead of the curve to optimize financial performance and patient care. In this newsletter, we […]
Health care in the United States is constantly changing, with new regulations and policies being developed to improve patient outcomes, increase access to care, and reduce costs. Impact of Healthcare Reform on RCM, keeping up with these changes is essential for Revenue Cycle Management (RCM) professionals. New regulations can impact everything from billing and coding […]
Medical billing is shaped by healthcare reform, which is one of the most dynamic forces at play. Legislation, regulatory changes, and shifts in healthcare delivery models have led to a significant change in how providers bill. In response to the continued push for value-based care, increased patient responsibility, and technological advancements, medical billing is evolving. […]
As a result of the most recent provider lawsuit, IDR processing fees have been reworked. Since its inception on Jan. 1, 2022, the No Surprises Act (NSA) has had its growing pains, including four lawsuits challenging the process of Independent Dispute Resolution (IDR). Out-of-network services are paid for with this process when health plans, healthcare […]
More than a third of Representatives call on the federal government to revise No Surprises Act implementation, specifically around the independent dispute resolution process. A bipartisan group of 152 House members wrote to the secretaries of Health and Human Services, Treasury and Labor and urged them to amend the interim final rule (IFR) that will […]
Understanding the qualifying payment amount and the initial information on the independent dispute resolution process “should be a short-term priority for revenue cycle leaders and their teams,” says attorney Harvey Rochman. Earlier this month, the federal government released an interim final rule outlining certain provisions of the No Surprises Act (NSA), which is designed […]










