Resources
Insights, evidence and tools for revenue cycle leaders.
Field-tested playbooks, customer outcomes, and research from the teams that built RapidClaims — written for CFOs, RCM directors and HIM leaders.
Field-tested playbooks, customer outcomes, and research from the teams that built RapidClaims — written for CFOs, RCM directors and HIM leaders.
The denial letter is vague by design. The 835 carries the CARC and RARC the engine actually fired. Route denials by code, not by letter.
CMS-0057-F took effect January 1, 2026 — 7-day decision windows, specific denial reasons, public PA reporting ahead. This workbook turns the new rules into a weekly operating reference your RCM team can act on.
In 2025, providers spent $43 billion fighting denials — and 70% of those claims were eventually paid. The denial rate is the cover story. The numbers underneath it are the ones the finance committee should be reading.
CMS finalized the Transforming Episode Accountability Model with a target-price formula of five factors. Four are fixed before the patient reaches the table. Only one responds to the hospital — and it's set in the 180 days before surgery.
Eleven years after CMS introduced the X-modifiers, modifier 59 is still the most-audited modifier in commercial healthcare. Why the fix never worked.
Specialty-aware autonomous coding, evaluated honestly. Download the playbook: real benchmarks on accuracy, autonomy rate, and specialty depth across 25+ specialties.
Every coding leader wants a low query rate — it looks like clean documentation and fast throughput. But a query rate that's too low usually means the opposite: capture left on the table because asking would have stopped the clock. The metric isn't measuring quality. It's measuring how often productivity won.
One business collects clean claims for almost nothing. The other reworks denials at a multiple of the cost. Your blended number averages them into a single figure that describes neither - and hides where the money actually goes.
Both describe a second procedure inside another surgery's global period. One is a complication. One is unrelated. Pick wrong and you either leave money on the table - or hand a payer a clawback.
A medical-necessity denial is rarely a doctor disagreeing with a doctor. It is a claim failing to match a structured rule set the documenting clinician never sees — and often cannot read.
Stricter criteria than Medicare and a contract promising CMS-alignment — a 30 percent cut the page already settles. From Jefferson Health v. Aetna: three clauses to audit, the scenarios that get downgraded, and a workbook that scores your leverage.
Low denial rates can still mask 3 to 5 percent revenue leakage from undercoding and missed reimbursement. This briefing outlines the seven metrics that reveal hidden revenue leakage, plus the frameworks and actions needed to measure and recover it.
One email, every other Wednesday. Operator-grade analysis from our research team. 12,400+ subscribers across U.S. health systems.