How to Choose Expert Scalable Retrospective Reviews Support for Payors?
How do you choose expert, scalable retrospective review support without increasing organizational risk? Choosing expert, scalable retrospective review support comes down to this: You need a partner that can handle volume spikes, apply real clinical judgment, and produce audit-defensible outcomes, without creating downstream risk for your organization. That’s what leaders like you are ultimately searching […]
10 Reasons Why Evaluation & Management Codes Account for $4.39M of Missed Reimbursement
Where Is Revenue Leaking in Healthcare, and Why E/M Codes Are the Biggest Culprit? Healthcare leaders often ask a deceptively simple question:“Where is our revenue leaking, despite doing everything right?” For many organizations, the answer is hiding in plain sight. A national benchmark–based coding analysis reveals $7.35M in total compliant reimbursement opportunity, and $4.39M of […]
2026 Benchmark Data Reveals Why Post-Bill Coding Is Failing Specialty Practices
Why Relying on Post-Bill Coding Is Costing You More Than You Realize? If your organization is still relying on post-bill coding reviews to catch errors after claims go out, the 2026 benchmark data sends a clear message: that approach is quietly costing you revenue, time, and credibility with payers. Post-bill coding used to work. When […]
How Under-Utilized Counseling Codes Left $129,613 on the Table Despite Supporting Documentation
Why Under-Utilized Counseling Codes Are a Hidden Revenue Risk for Healthcare Leaders Healthcare leaders rarely worry about counseling codes being a major revenue lever. Yet, in one recent benchmark-driven coding analysis, $129,613 in legitimate, compliant reimbursement was left uncollected, not because care wasn’t delivered, not because documentation was missing, and not because of compliance risk, […]
Why 10–15% Benchmark Variance in Routine Visits Can Quietly Cost Healthcare Systems Millions
How “Acceptable” Revenue Performance Masks Multi-Million-Dollar Losses? If your organization’s routine outpatient visits are running 10–15% below benchmark on clinical documentation accuracy, clean claim rate, or payment realization, you are almost certainly losing millions of dollars a year, even if your revenue reports look “acceptable” on the surface. And here’s the uncomfortable part:Most healthcare leaders […]
25 Ways How Concurrent Coding Improves RAF Scores Without Triggering Upcoding Risk
Why RAF Improvement Has Become a High-Risk Leadership Challenge? If you’re accountable for RAF performance, you’re under pressure from two sides. On one side, value-based contracts, Medicare Advantage plans, and payors expect accurate risk capture. On the other, CMS scrutiny around RAF inflation, RADV audits, and upcoding allegations has never been higher. This creates a […]
15 Things to Expect From a Payor-Led Retrospective Review Engagement
Why Payor-Led Retrospective Reviews Are Now a Financial and Audit Imperative If you are a payor leader in charge of Risk Adjustment or Provider Network Management, a payor-led retrospective review engagement is no longer a “nice-to-have.” It is a core financial, compliance, and performance strategy.At its core, a retrospective review answers one critical question:Did your […]
How Concurrent Coding Increases E/M and Procedure Volume by 26%
Does Concurrent Coding Really Increase E/M and Procedure Volume by 26%? Yes, and not because organizations are “coding more aggressively,” but because they’re finally capturing the full clinical story at the right time.Healthcare organizations that implement concurrent coding consistently report double-digit improvements in E/M level accuracy and procedure capture, with many seeing up to a […]
How National Coding Benchmarks Exposed a $7.35M Revenue Gap in a Single Healthcare Organization
Why Healthcare Leaders Are Reexamining Revenue Capture Through National Benchmarks Healthcare leaders often ask a simple but high-stakes question: “Are we actually capturing the full value of the care our clinicians deliver?” For one multi-specialty healthcare organization, the answer emerged with striking clarity using a PHI-free coding benchmark analysis. The national coding benchmark analysis uncovered […]
How Revenue Cycle Directors Can Optimize Annual Wellness Visits for Better Reimbursement
How do Revenue Cycle Directors maximize reimbursement from Annual Wellness Visits (AWVs) in 2026? If you are a Revenue Cycle Director, the short answer is this: You maximize AWV reimbursement by combining compliant CPT billing, proactive eligibility verification, accurate risk adjustment capture, and denial-proof documentation, before the patient ever walks into the exam room. In […]