Everything you wish someone told you about automating RCM
From failed bots to million-dollar recoveries – stories, frameworks, and lessons from the field.
Featured insights
.png)
.png)
.png)
XiFin - 101 Guide
When a private equity firm holds a healthcare technology company for twelve years–nearly double the industry standard–it tells a story. Whether that narrative speaks to product maturity or exit market challenges remains an open question, and one that diagnostic billing leaders should answer before signing multi-year contracts with XiFin. This article is exactly about this.
.png)
athenahealth Automation | 2026
athenahealth automation can be fully standardized. The platform excels at automating common workflows like billing and eligibility, but limits customization through its shared rules engine. The challenge is balancing what athenahealth standardizes with what your organization actually needs to control.
.png)
"Contractual Adjustment (Allowance)" - Term Explanation
A contractual adjustment is the mandatory write-off applied when a provider's billed charge exceeds the amount an insurer has agreed to pay under contract. It is not lost revenue — it is non-collectible by design. But when tracked incorrectly, it can mask real underpayments and inflate your apparent collection rate.
.png)
"Denials Appeal" - Term Explanation
A denials appeal is the formal process a provider uses to challenge a payer's decision to deny a claim. Appeals are worth pursuing — but with commercial plan overturn rates falling from 56% to 45%, success increasingly depends on documentation quality, payer-specific strategy, and speed.
.png)
"Credit Balance Resolution" - Term Explanation
Credit balance resolution is the process of identifying and returning overpayments to payers or patients. It is not optional — federal law requires providers to repay identified Medicare and Medicaid overpayments within 60 days. Unresolved credit balances are both a compliance liability and a distortion of your AR.
.png)
What is HRA? | 2026
Health Risk Assessments (HRA) have evolved from simple questionnaires into critical infrastructure for population health and revenue cycle strategy. This guide explores how HRAs identify hidden patient risk, impact care management, and drive financial performance—along with the operational frameworks needed to make them actually work.
.png)
Revenue Cycle Management in Cardiology
Fnancial pulse of a cardiac practice requires demands a specialized approach: the Cardiology Revenue Cycle Management (RCM). As clinical procedures become more complex - ranging from diagnostic imaging to intricate interventional electrophysiology - the administrative back-end must be equally sophisticated to ensure financial viability.
.png)
No Suprises Act from RCM perspective | 2026
The No Surprises Act reshaped how healthcare providers handle billing, compliance, and patient protections. This guide explains the law’s key provisions, its impact on revenue cycle management, and the steps healthcare organizations must take to remain compliant and avoid costly billing disputes.
.png)
"Clinical Documentation Integrity (CDI)" - Term Explanation
Clinical Documentation Integrity (CDI) ensures a patient's medical record accurately captures the full scope of services, diagnoses, and severity of illness. Weak CDI is a silent revenue leakage driver — undercoded encounters, missed diagnoses, and unsupported claims trace directly to documentation gaps that automation and structured review programs can close.
Dental Revenue Cycle Management | 2026
Efficient revenue cycle management prevents "revenue leakage," where services are performed but never fully reimbursed. In 2025, dental services have shifted from semi-automated case processing to vast human-in-the-loop automations and predictive analytics. Interested in more detail on this transformation? Here’s our take on the best strategies for dental RCM in 2026.