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Medicare Advantage (MA) enrollment continues to rise across the United States, making MA plans a critical revenue source for providers. However, increased plan oversight, stricter authorization rules, and heightened audit activity are creating new operational and reimbursement challenges. At Total RCM Solutions, we work closely with providers to navigate these evolving Medicare Advantage requirements while […]

Congress has passed a FY 2026 “minibus” appropriations package that includes funding for the Department of Health and Human Services (HHS) along with several important healthcare policy updates. While the bill does not extend enhanced ACA premium subsidies, it delivers meaningful changes that directly impact providers, billing teams, and revenue cycle management (RCM) organizations. Rather

The 2026 CPT® code set introduces one of the most significant updates in recent years, with extensive changes across multiple specialties. These updates reflect advancements in medical technology, evolving care delivery models, and CMS’s ongoing efforts to improve coding accuracy and reimbursement alignment. For providers, coders, and revenue cycle management (RCM) teams, understanding these changes

As 2026 begins, U.S. healthcare providers are operating under a new set of payer and regulatory rules that directly impact reimbursement, coverage eligibility, and revenue cycle workflows. Several Medicare, Medicare Advantage (MA), and ACA Marketplace policies finalized in 2025 took effect on January 1, 2026, making early-year execution critical for financial stability. This blog outlines

Payer denials continue to be one of the biggest revenue challenges for healthcare practices and billing companies. Denied claims slow down reimbursement, increase administrative effort, and reduce financial stability. Traditionally, billing teams identify trends only after denials start piling up — making the process reactive and time-consuming. Today, Artificial Intelligence (AI) is transforming denial management

CPT modifiers may look like minor additions, but they play a crucial role in explaining the “how,” “why,” and “where” of a service. Correct use of modifiers can ensure cleaner claims, faster reimbursements, and compliance with payer policies. As we move through 2025, payer scrutiny around modifier usage continues to increase. This blog explores some

Pediatric billing isn’t just a smaller version of adult billing—it’s a specialized workflow with its own set of codes, payer rules, and compliance risks. From well-child visits and immunizations to Medicaid nuances and newborn enrollment, pediatric revenue cycle management (RCM) requires precision at every step. Here’s a step-by-step breakdown of how to manage pediatric billing

Billing transparency isn’t just good practice—it’s good medicine. A clear and honest billing process strengthens the provider-patient relationship, reduces disputes, and enhances your reputation in a competitive healthcare market. By adopting these best practices, healthcare providers can create a more transparent, equitable, and patient-centered billing experience.