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Why Claim Denials Hit Tribal Health Harder—and How RCM Teams Can Reverse the Trend

Claim denials continue to rise across the healthcare landscape, and Tribal Health Organizations (THOs) remain among the most affected. Revenue cycle leaders across Tribal Health Centers, health departments, and Purchased/Referred Care (PRC) programs face payer complexity, stricter documentation requirements, and administrative pressures that far exceed those of most non-Tribal organizations. ...Read More

Blogs

The AI-Driven Compliance Crucible: Navigating the Next Decade of Medical Billing and RCM Transformation

Healthcare revenue cycle—the people, the processes, and the technology—are currently undergoing a revolution. It presents a dual challenge: the rapid adoption of Artificial Intelligence (AI) and automation to optimize cash flow, in contrast to the increasing prevalence of patient-centric laws, such as the No Surprises Act (NSA). For Chief Financial ...Read More

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How HCC Coding Companies Help Your RAF Scores Tell the Real Story

Ever stare at your RAF scores and think, “These can’t be right?” You know your members are complex. You see the chronic conditions and comorbidities. Yet on paper, the numbers don’t add up…and it feels like money, time, and hard work are slipping through the cracks. Chances are you’ve sat ...Read More

Blogs

5 Denial Management Tactics That Save Millions from the Write-Off Pile

Denials are deflating. Every time one hits your desk, it’s enough to ruin your day. More rework. More delays. And another dent in margins that already feel razor-thin. You’ve probably had a claim you thought was airtight come back rejected. You shake your head…knowing your team will burn hours unraveling ...Read More

Blogs

Retrospective Risk Adjustment: The Shortcut to Capturing Every Dollar You’ve Earned

Margins are razor thin in 2025. And yet, millions still slip away quietly. The endless cycle of missed HCCs, incomplete charts, documentation gaps, and other missteps adds up fast. It feels like trying to fill a bucket with holes. No matter how much effort your team pours in, the revenue ...Read More

Blogs

The RCM in Medical Billing Checklist: 9 Essentials to Keep Revenue Flowing Without Disruption

Billing today feels like walking a tightrope. One wrong step and your entire revenue cycle starts to wobble. A missed authorization or data entry error can lead to rejected claims, denials, and backlogs that drain staff time. Isn’t there another way? It all comes down to systems. And it starts ...Read More

Blogs

The Truth About Why Your Revenue Cycle Management Isn’t Delivering Stable Income

The inconsistency is starting to wear on you. One month, your cash flow’s smooth sailing. The next, you’re bracing for impact—wondering how you’ll cover payroll or fund the next big initiative. It’s maddening, right? Maybe you’ve run the reports, triple-checked your denial rates, and even tightened up collections. And yet…the ...Read More

Blogs

Why Zero Balance Management Could Be the Answer to 2025’s Financial Squeeze

It’s late. The office is quiet except for the hum of your computer. Month-end close is on your desk, and you’re staring at a wall of numbers. While at first glance everything looks fine, the longer you study the reports, the more uneasy you feel. Something’s missing. The totals don’t ...Read More

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