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CMS-0057-F doesn’t eliminate prior authorization — it modernizes it. Here’s what’s changing, when it takes effect, and which services commonly skip PA entirely.
A perfectly coded claim can still generate `$0 if it reaches the payer one day late. See typical payer deadlines and how high-performing RCM teams prevent this entirely avoidable loss.
Denials sit at 8–12%, but 60–70% are preventable. See the consistent pattern behind stuck revenue across Epic, athenahealth, and eClinicalWorks practices.
Even with modern EMRs in place, most practices still leak 8–12% of revenue to denials. The real issue isn’t the platform — it’s execution.
Up to 60% of denied claims are never reworked, and 65%+ are preventable. See the most common denial drivers — and why they keep happening.
Your team is working, your vendor is delivering, your reports look detailed — and revenue is still leaking. That’s a design problem, not a people problem.
AI isn’t replacing RCM — it’s enabling it. See where AI delivers real value, what it can’t replace, and why human-led, AI-enabled is the winning model.
Across multiple athenahealth setups, we consistently see 8–12% denial rates and 10–15% revenue leakage — often unnoticed. See where it actually starts.
8–12% revenue leakage is common in AdvancedMD setups and often goes unnoticed. Good software doesn’t fix broken processes.
We often see 6–10% revenue leakage even in well-configured Epic environments. Epic doesn’t limit performance — operational discipline does.
High-performing organizations don’t manage revenue by intuition. See the 12 disciplined KPIs that provide early visibility before revenue is lost.
A billing team cannot recover revenue lost to inaccurate registration or missed authorizations. See where billing ends and full RCM strategy begins.
Many denials are created before a claim is ever submitted. See the 7 most common front-end mistakes and why prevention beats recovery.
Selecting an RCM partner is about more than outsourcing billing. 12 questions to ask before you sign — from EMR compatibility to measurable outcomes.
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