Claim scrubbing software checks a claim for errors before it ever reaches a payer — mismatched codes, missing modifiers, invalid NPIs, and formatting problems that would otherwise bounce the claim back or trigger an automatic denial. It catches a meaningful share of preventable…
CMS Physician Fee Schedule 2027: What Changed and Who’s Affected
CMS released its CY 2027 Medicare Physician Fee Schedule proposed rule on July 14, 2026, and the headline number is a pay cut: both conversion factors drop from their 2026 levels because a temporary 2.5% statutory increase Congress provided for 2026 expires at…
Aetna Timely Filing Limit for Claims: What Physician Practices Need to Know
Aetna’s timely filing limit for in-network commercial claims is generally 90 days from the date of service, while out-of-network and non-participating claims get 12 months. But that’s a starting point, not a universal rule — the actual deadline on any given claim depends…
What Is an EOB (Explanation of Benefits)? A Guide for Physician Practices
An EOB, or Explanation of Benefits, is the statement a payer sends after processing a claim that shows what was billed, what the payer allowed, what it paid, and what the patient owes. It is not a bill itself — it’s the paper…
NPI Number: What It Is and How to Apply for One
An NPI number is a 10-digit identifier that CMS assigns to every healthcare provider and organization that bills insurance or shows up in a HIPAA-covered transaction. Every physician needs one before they can bill a single claim, and applying through NPPES online costs…
CAQH ProView: How to Set Up and Maintain Your Profile Correctly
A huge share of credentialing delays trace back to one thing: a CAQH profile that’s incomplete, expired, or just wrong in a small way nobody caught. CAQH ProView is the system nearly every commercial payer pulls from before they’ll even start credentialing a…
Patient Collections Without Surprises: A Front-Desk Revenue Cycle Checklist
Patient collections work best when expectations are clear before the visit, balances are accurate, and staff have a consistent workflow.
Payment Posting: The Quiet RCM Step That Finds Underpayments and Denial Patterns
Payment posting is more than data entry. It is where practices can catch underpayments, denial trends, patient balances, and payer issues early.
Claim Rejections vs. Claim Denials: What Your Billing Team Should Work First
Claim rejections and denials are often discussed together, but they require different workflows, owners, and reporting.
Clean Claim Rate: What It Measures and How Physician Practices Can Improve It
Clean claim rate is one of the clearest indicators of billing quality. Learn what affects it and how practices can improve claims before submission.