Sasha
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Jack Smith walks into the medical practice for a regular visit. Nothing dramatic. No red carpet. No thunderstorm. Just Jack, his insurance card, and the hope that grown adults in a medical office know how to read an EOB (explanation of benefits). How nice. The visit gets billed. The insurance company processes the claim. The…
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Let me say something that sounds ridiculous but is completely normal in the United States: your access to healthcare depends on your job. Not your health, not your needs, not your situation. Your job. Lose your job, and you are not just losing income. You are losing your insurance, your medical care, your medications, and…
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Patients believe insurance exists to cover the cost of care. That is a reasonable assumption. It is also a wrong one. The real power in American healthcare has nothing to do with who treats you. It has everything to do with who decides whether you get treated at all. Right now, that power belongs to…
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You think your billing company is the problem. Nope. It is your front desk. But let us back up. Because Holly has entered the building. You remember Holly. She consults. She observes. She generates recommendations in a font size that suggests authority. She has been in healthcare administration long enough to have opinions about everything…
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Chad the Auth Guy is staring at his computer screen like it just asked him to solve world hunger. He’s got eight tabs open. None of them is the AMA’s (American Medical Association) CPT update page. One of them is definitely ESPN. Another is his fantasy football league. The rest? Who knows. Chad’s been assigned…
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Monica, the lead biller, hits submit on a clean claim. CPT 99214. Office visit. Jack Smith has a stomach ulcer, confirmed by the physician. Chart note is complete. Everything is signed. Coding is tight. Submitted at 8:01 AM. At 8:01 and 5 seconds, the denial lands. “Documentation does not support medical necessity.” Monica stares at…
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Let’s stop pretending this is complicated. If you’ve ever picked up a prescription and felt like you were being mugged at the pharmacy counter, you were. Welcome to American healthcare, where the same exact medication costs three times more than it does in Canada, and the only explanation you’ll get is a shrug and a…
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Let’s talk about how Big Pharma keeps making billions off something your cousin’s knockoff bag business also does: slap a new label on the same product and sell it for double. Welcome to the shady world of “me-too” drugs, where pharmaceutical companies slightly tweak a chemical formula just enough to get a brand-new patent, jack…
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Payment posting is treated like clerical work. Something routine. Something anyone can do if they click fast enough. That way of thinking is exactly how revenue slips away unnoticed. Most medical offices think money gets lost at the claim denial stage. It does not. Denials are obvious. They show up on reports. They get attention.…
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The Problem With Patient Responsibility No One Admits… Everyone loves to complain about patients not paying their balances. Here is the uncomfortable truth. Most of those balances should never have been the patient’s responsibility. Patient responsibility is not a collections issue. It is a workflow failure wearing a fake label. I see this constantly. An…