How a 6-Hospital System Cut Denials 66% in Four Months
A regional health system was losing an estimated $4M a year to preventable denials across departments. Here's the rollout that turned that around.
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Guides, updates
Guides, updates
and insights.
Coding changes, revenue cycle guides and thinking on where AI helps in medical billing, and where it doesn't.
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Coding & CMS UpdatesAI in HealthcareRevenue Cycle GuidesCase StudiesWhite PapersProduct & WebinarsDocumentation & API
CMS Finalizes 2026 Physician Fee Schedule: What Changes for E/M Coding
A breakdown of the E/M and conversion factor changes billing teams need to account for starting this year, and where the biggest reimbursement shifts land.
ICD-10-CM FY2026 Updates: The New Codes You Need to Know
This year's ICD-10-CM update adds new codes and revises several existing categories. Here's what actually affects day-to-day coding.
CPT 2026 Category I Changes: New Codes for Remote Physiologic Monitoring
Remote monitoring billing gets several new Category I codes this cycle. A practical look at documentation requirements for each.
The Five Most Common Modifier Errors We See in Cardiology Claims
Modifier 25, 59, and 26 account for a disproportionate share of cardiology denials. Here's how each one actually gets misapplied.
Where AI Actually Helps in Medical Coding, and Where It Doesn't
AI coding tools are good at pattern recognition across huge volumes of documentation. They're not good at judgment calls with clinical ambiguity. Knowing the difference matters.
Why Confidence Scores Matter More Than Accuracy Claims
A vendor claiming '95% accuracy' tells you nothing about which 5% is wrong. A confidence score tells a coder exactly where to look.
The Case for Keeping a Human in the Loop on Every Claim
Full automation sounds appealing until you're the one explaining a claim to a payer auditor. Why provider review isn't a bottleneck, it's the safeguard.
A Practical Guide to Reducing Denial Rate Below 5%
Most practices plateau around 8-10% denial rate. The path below 5% isn't one big fix, it's five specific, compounding changes.
Prior Authorization: A Field Guide for Billing Teams
Which procedures actually need prior auth, how to build the documentation payers want the first time, and how to track requests that go quiet.
Days in A/R: Benchmarks by Practice Size
What's actually normal for a 3-provider practice versus a 40-provider group, and the point at which slow A/R starts signaling a deeper process problem.
A 3-Provider Practice Eliminated Sunday Night Billing
The owner of a small cardiology practice used to do billing after hours every week. Here's what changed when review dropped to ten minutes a day.
The True Cost of Claim Denials in Multi-Specialty Groups
A deep-dive analysis of direct and hidden denial costs (rework hours, delayed revenue, and write-off decisions) across a 40-provider group.
FQHC Billing Compliance: A Complete Reference
PPS billing, wraparound payments, and Medicaid managed care rules in one reference built specifically for FQHC billing teams.
Product Update: Payer Intelligence Now Covers 40+ Regional Plans
This release extends payer-specific edit modeling to 40 additional regional Medicaid managed care and commercial plans.
Webinar Recording: Denial Prevention Office Hours
Our revenue cycle team answers live questions on denial patterns, appeal strategy, and where AI review fits into an existing billing workflow.
Getting Started with the Althais API
An overview of how Enterprise integrations connect to Althais: coding suggestions, claim status, and analytics as structured data.
Authentication & Rate Limits
How API credentials are issued for Enterprise accounts, and the request limits that apply per organization.
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