Healthcare organizations face immense pressure to capture all dollars they’ve earned. Revenue leakage can happen throughout an organization’s revenue cycle, whether due to incomplete documentation or coding inconsistencies, claim errors, avoidable denials, or delayed follow-up.
8 Ways AI Is Closing the Revenue Gap in Claims, Coding, and Documentation Read Post »
The trouble with the word “defensible” is that you cannot test it at the moment you are buying.
What “Defensible” Should Mean When You’re Vetting a QME/IME Record Review Partner Read Post »
The medical chronology vs. deposition summary question is usually framed as a preference. It is closer to a question of audience: the two documents are written for different readers, and an evaluator who handed the wrong one pays for it in evaluation time.
Deposition Summary vs. Medical Chronology: What IMEs Actually Need Read Post »
The question that has been put forward focuses on why a practice would invest in a third-party revenue cycle management (RCM) automation platform when electronic health records (EHRs) can already automate numerous tasks related to the revenue cycle. It is essential to understand the potential benefits that third-party RCM platforms can bring to practices and what advantages they have over the automation features of EHRs.
Why Adopt Third-Party RCM Automation When Your EHR Already Has Built-In Automation? Read Post »
In California workers’ compensation, an incomplete record set does not simply slow the evaluator down. It routes the file into one of four named outcomes, each with its own clock and its own price.
How Incomplete Records Delay QME Evaluations in California Workers’ Comp? Read Post »
The 2026 California UR regulations were filed with the Secretary of State on December 30, 2025 and took effect April 1, 2026. They amend a long list of sections in Title 8: 9767.6, 9781, 9785, 9785.6, 9786, the 9792.6 through 9792.15 series, and 9792.27.1 and 9792.27.17.
Start with what did not change. Labor Code section 4610 is intact. IMR is still the forum for medical necessity. The 30-day exemption and the formulary exemptions still exist.
California UR Regulations 2026: What Changed on April 1 and How to Challenge a Denial? Read Post »
A chronology built for one case is a document. A chronology built for a cohort has to be a dataset. Most mass tort record review produces the first thing and then needs the second.
Medical Record Review for Mass Torts: The Cohort Chronology Problem and How to Solve It? Read Post »
CMS does not reject an incomplete Medicare Set-Aside submission. It fills the gaps with defaults, and the defaults run against the payer.
Liability in a California cumulative trauma claim reaches back one year. The record that decides where that year falls reaches back much further.
Healthcare revenue cycle automation has come a long way. Not long ago, revenue cycle professionals were spending hours verifying insurance, checking the status of claims, applying payments, and following up on denials.
Why Revenue Cycle Automation Still Needs Human Expertise in the Loop? Read Post »
