BLOGS

Healthcare practices are facing growing pressure as medical billing and revenue cycle management become harder to sustain internally. Rising claim denials, tighter payer requirements, authorization delays, and staffing constraints are disrupting cash flow across specialties. This article examines why getting paid has become more difficult heading into 2026 and how practice leaders can gain clarity on what revenue is still recoverable before it expires.

Modifier denials in healthcare are rising across every specialty in 2025. Most of the patterns trace back to a small group of high-risk billing modifiers — including Modifier 25, Modifier 59, Modifier 24, and the X-modifiers — that payers now flag more aggressively. These denial trends reveal workflow gaps long before aging A/R exposes the problem. If your practice is seeing more claim denial patterns tied to modifiers, the data is signaling a revenue cycle issue worth paying

When UNC Health and Cigna failed to reach a contract agreement, 60,000+ North Carolina patients were left scrambling. But the deeper lesson isn’t just about one health system — it’s about how downcoding, administrative overload, and payer tactics are threatening revenue and continuity of care nationwide. This post breaks down the real risks, early warning signs, and how providers can proactively protect their revenue and patients before their own contracts are at risk.

With only days left before October 1, physicians must understand what’s really at stake. A mid-sized practice that bills for 20 high-level visits per week could lose $4,000 to $5,000 per month if claims are downcoded. Over 12 months, this amounts to nearly $50K in lost reimbursements. On October 1, 2025, Cigna Healthcare will enforce its new Evaluation and Management (E/M) Coding Accuracy (R49) Policy. This change is significant for many physicians; it represents a seismic s

In 2026, modifiers such as KX, CQ, and CO will be under tighter scrutiny than ever before. This means that physical therapy clinics without airtight processes are not just risking denials; they’re also risking audits and penalties.

Let’s face it, physical therapy billing write-offs are nobody’s favorite line task. Every week, PT clinics quietly sweep denied or unpaid claims under the rug, assuming they’re too small or too late to chase. It feels easier in the moment, but behind each “adjustment” lies potential revenue slipping through your fingers.

Running a healthcare business may cause you to want to handle billing in-house. This method provides comfort, control, and saves on outside service costs.