Practice Finance

As physicians, payers and independent reviewers all adopt AI for utilization review and No Surprises Act disputes, audit trails and human oversight will determine which practices come out ahead.

The license fee is the number on the proposal. These 10 costs arrive after the contract is signed, and the biggest never shows up on an invoice.

A new Kodiak report shows prior authorization and medical necessity denials accounted for nearly all of the 25% jump in revenue leakage. Here are four steps practices can take now to fix that.

The CMS-0057 rule regulates health plans. The question that matters is: Which of your payers will be live in your EHR on Jan. 1?

It's shared savings season and the check has arrived. Now how do physicians divide it up fairly?

Urban Institute analysis finds 26% of insured adults owe medical debt, with hospitals the largest source

A simple break-even calculation turns a reimbursement advantage into staff minutes, showing practices when prior authorization, denials and uncollected patient balances wipe out a better rate.

Recent CMS rule changes reinforce that operational discipline is increasingly shaping reimbursement

Medical Economics spoke with Monique Delgado, former CEO of Integrated Medical Services, about where salary-only pay falls short, which metrics to tie incentives to and how to change physician pay without eroding trust.

Coding scrutiny, payment gaps and a push for price caps show up across Trilliant Health's annual look at where U.S. health care is headed.

Trilliant Health's annual trends report traces primary care shortages, payment gaps and looming price caps to incentives no single stakeholder has reason to fix.

It's not a patient problem, it's an operations problem, and large practices and health systems need to treat it that way.

HHS finalizes price transparency updates as employers push insurance vendors to open the books.

EBRI data show employer plans pay hospital outpatient departments about twice what physician offices receive for the same physician-administered drugs, and the commercial market has barely begun to address the gap.

Why physicians owe tax on their share of practice profit rather than the cash they take out, and how entity type, footnotes and late K-1s can change the final bill.

From a same-day payment cut to AI-run prior authorization in traditional Medicare, MGMA's government affairs team laid out what Washington has in store for physicians next year.

MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.

At an MGMA Government Affairs town hall, attendees raised extrapolated audits, employer plans beyond state reach and denials with no reason codes.

Start with a spreadsheet, add curiosity and communication, and make a real difference to practice income.

Behavioral health has historically taken a back seat to physical health in primary care. That approach is shifting, as growing evidence underscores the importance of whole-person well-being in improving patient outcomes, strengthening care coordination and advancing value-based care.

No U.S. state scores even 2 out of 5 on patient sentiment about billing

It’s no surprise costs are outpacing revenues. Here are three strategies to bring in more income.

U.S. health care has a patient loyalty problem hiding in plain sight, says a new report based on a survey of 10,000 consumers.

A primary-care voucher model would pay practices upfront for predictable care and leave insurance to cover catastrophic risk, cutting administrative burden and giving physicians time back with patients.

CMS chief says outcomes-based pay can help patients while finally ending physicians' box-checking frustration.