What Is the CY2026 Efficiency Adjustment and How Does It Impact Internal Medicine Billing?

-
Image
The CY2026 Efficiency Adjustment is one of the important changes introduced under the 2026 Medicare Physician Fee Schedule. Effective January 1, 2026, CMS finalized a 2.5% reduction to the work RVUs of most non-time-based services . However, the adjustment does not apply broadly to every service billed by an internal medicine practice. Time-based services, including many evaluation and management (E/M) and care management services, are excluded. For internal medicine practices, understanding which services are affected is important because the adjustment can change reimbursement for certain procedures and ancillary services even when claims continue to process normally. For a detailed overview, practices can review What Is the CY2026 Efficiency Adjustment and How Does It Impact Internal Medicine Billing? . What Is the CY2026 Efficiency Adjustment? CMS finalized the efficiency adjustment as part of the CY2026 Physician Fee Schedule. The policy applies a -2.5% adjustment to the work comp...
Post a Comment

Why does your Staff Fail to Collect Revenue from Patients?

-

 

whydoesyourstafffailtocollectrevenuefrompatients.jpg

After 25 years of training medical practice staff how to successfully ask patients to pay at the point of service, there are many common excuses that we hear when staff members fail to collect Revenue from Patients. As per the Consumer Financial Protection Bureau (CFPB) report released in December 2014, 43 million citizens have overdue medical debt and a staggering 52 % of all debt on credit reports is from medical billing. The findings of the study clearly indicate that patient collection is becoming a  serious threat to the profitability of the provider’s office. Factors like ongoing economic instability combined with the implementation of the Affordable Health Care Act and the shift in payment models to be consumer-direct with high deductibles have all consolidated into greater difficulties for the provider’s office at revenue collection from patients.

Reasons Your Staff Fails to Collect Revenue from Patients

To elaborate, here are a few reasons why provider’s offices fail, and steps the office can take to increase collections from patients: 

1. Vague financial policy and procedures

Medical billing and revenue cycle can be complex and confusing concepts. The lack of crystal clear written policies and procedures at the disposal of the provider’s staff only aggravates the problem. Ideally speaking, the policies should clearly outline what the payers consider acceptable and information in terms of patient payment timing and extended payment plans.

The staff should be educated about the difference in payment responsibilities when the patient is not insured, out of network, and alternatively covered by a contracted plan; something the staff of medical revenue billing services is well-versed with.

2. Sharp rise in the volume of patients

Approximately, 40% of adults, who were earlier not covered by payers due to factors like age, gender, health history, etc., will now obtain coverage, thanks to the new Affordable Health Care Act which requires insurance companies to cover such cases regardless of pre-existing conditions. As a result, a substantial rise in health insurance enrollments is impending.

Quantum could become an issue and if that happens, quality would be at an obvious risk. The new rules also provide for increased expenses and thus more confusion. The trend is bound to result in more medical billing errors and the necessity to re-submit claims. Indeed, the provider’s staff is bound to find itself at the end of its wits if not trained to be well-acquainted with new procedures. Read Continue: Why Does Your Staff Fail to Collect Revenue from Patients?

Location: United States

Comments

Post a Comment

Popular posts from this blog

Is Your Neurology Billing Outsourcing Helping or Hurting You at Year-End?

-
Image
  As year-end approaches, neurology practices face a crucial decision: Is your billing outsourcing truly improving your financial performance, or silently affecting your revenue? Neurology billing is complex due to time-based coding, modifier usage, high documentation requirements, frequent audits, and prior authorization challenges. If your billing partner lacks neurology-specific expertise, it may lead to claim denials, revenue loss, and compliance risks. Signs Your Neurology Billing Outsourcing Is Helping If your billing partner is performing well, you will see: • Reduced denial rates for neurology codes (EEG, EMG, Botox, Nerve Conduction Studies) • Faster reimbursements and fewer delays from payers • Active recovery of old AR beyond 60, 90, or 120+ days • Accurate CPT, ICD-10, and modifier usage for neurology procedures • Clear billing reports, denial analysis, and revenue insights • Compliance with Medicare, commercial payers, and documentation standards Warning ...
Read more

How Hidden OB-GYN Billing Errors Are Quietly Costing You Millions Each Year

-
Image
  The Silent Revenue Leak in OB-GYN Practices Most OB-GYN practices don’t realize they’re bleeding money. Not in dramatic, headline-grabbing ways, but quietly, steadily, month after month. The phones are ringing, appointment slots are full, deliveries are happening, and yet the numbers never seem to match the effort. Sound familiar? This is often the first sign of hidden OB-GYN billing errors working behind the scenes. These errors don’t announce themselves. They don’t crash your systems or send angry alerts. Instead, they slip through claims, hide in coding nuances, and quietly shave thousands—or millions—off your annual revenue. OB-GYN billing is uniquely complex compared to other specialties. Between global maternity packages, split billing scenarios, high-risk pregnancy coding, and ever-changing payer rules, the margin for error is enormous. A single missed modifier or incorrectly bundled service might seem insignificant on its own. But when repeated across hundreds or thousand...
Read more

The #1 Reason ASCs Lose Revenue from Medicare Claims (And How to Fix It)

-
Image
Ambulatory Surgical Centers don’t lose Medicare revenue because of low case volume. They lose it because of one recurring, preventable failure: Incorrect coding and documentation for Medicare’s ASC-specific payment rules. This single issue triggers denials, underpayments, delayed reimbursement, and permanent write-offs — especially at year-end. If your ASC’s Medicare revenue feels unpredictable, this is why. The #1 Revenue Killer: Not Billing Medicare the “ASC Way” Medicare does not treat ASCs like hospitals or physician offices. Yet many ASCs still: Use hospital-style assumptions Miss ASC-only payment rules Underestimate Medicare’s bundling logic The result? Claims get paid less than expected — or not at all. Where Medicare ASC Claims Go Wrong 1. Incorrect CPT eligibility for ASC payment Not every CPT code is payable in an ASC setting under Medicare. Common mistakes: Billing procedures not on Medicare’s ASC approved list Assuming “covered in hospital” = “covered in ASC” Missing annual...
Read more