Blog
Field notes on getting claims paid.
Practical writing on AR follow-up, denial prevention, payer behavior, and how automation is changing revenue cycle work.
October 14, 2026
First federal prior auth data is in. Use it on your payers
KFF's first analysis of mandated transparency data finds prior auth denial rates of 12 to 18 percent by market, ranging from 2 to 25 percent by insurer.
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September 23, 2026
Commercial rates are frozen. Your AR workflow should not be
MGMA finds half of medical groups have gone three or more years without a commercial rate increase while costs keep climbing. Sharper AR is the lever.
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September 2, 2026
Days in AR is holding steady. That is worse than it sounds
MGMA's July poll found 32 percent of practices saw AR days rise in 2026, driven by payer delays and denials. Stability at a bad number is drift.
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August 12, 2026
Appealed prior auth denials mostly win. Few are filed
A new OIG analysis found MA organizations overturned 95 percent of appealed SNF prior auth denials. Two-thirds of patients never appeal at all.
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July 22, 2026
Medicare Advantage denies most post-acute prior auths
KFF finds MA insurers deny 65 percent of long-term care hospital and 54 percent of rehab prior auth requests. Appeals are where the revenue comes back.
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July 1, 2026
Operating costs are up 11 percent. Billing is the lever
MGMA finds 84 percent of medical practices face higher operating costs in 2026, up about 11 percent. Most practices cannot bill their way out by adding staff.
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June 9, 2026
99 percent of Medicare Advantage enrollees face prior auth
KFF's June 2026 brief finds 99 percent of MA enrollees need prior auth, including 97 percent for hospital stays. Authorization now decides payment.
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May 19, 2026
Who regulates the algorithms denying your claims
KFF's May 6 brief maps the thin patchwork of federal and state rules governing AI in prior auth and claims review. Providers need their own audit trail.
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April 28, 2026
Insurers cut 11 percent of prior auths. Queues still grow
AHIP and BCBSA report insurers eliminated 6.5 million prior auths, a 15 percent cut in Medicare Advantage. Progress at the payer does not fix the workflow.
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April 7, 2026
Fewer than 1 in 100 denied claims ever get appealed
KFF finds insurers denied 20 percent of 2024 marketplace claims while fewer than 1 percent were appealed. Unappealed denials are a quiet, recoverable loss.
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March 17, 2026
The industry spends $25 billion a year fighting denials
HFMA estimates providers spent over $25 billion contesting claim denials in 2023, up 23 percent. A clean claim audit is where that money stops leaking.
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February 24, 2026
Prior authorization is now a patient experience problem
A KFF poll out February 2 finds 69 percent of insured adults call prior authorization a burden. For providers, that friction shows up in AR too.
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February 3, 2026
Payers use AI on your claims. The answer is not more staff
Kodiak Solutions data shows initial denial rates at 11.65 percent for 2025 while payers adjudicate in seconds. Matching that speed takes automation.
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January 15, 2026
Most denials are won on the day the claim goes out
MGMA's January 2026 poll puts denials and appeals first among revenue cycle leaks. The fix is upstream prevention, not faster appeal writing.
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January 15, 2026
Welcome to the QHB blog
Field notes on AR follow-up, denial prevention, and the work between submission and payment.
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