https://hnabusinessgroupmd.com/

HNA Business Group MD, 1500 N Grant Street #4188, Denver, CO (2026)

10/01/2026

Auth approved for April 15. Patient reschedules to April 28. Auth expired April 20.

The service was approved. The patient was covered. The practice did everything right. And the claim pays zero.

Expired authorization denials are the most frustrating category in billing, because nothing clinical went wrong. A date moved.

Here's what most practices don't realize changed this year.

As of January 1, 2026, CMS-0057-F requires Medicare Advantage, Medicaid, CHIP, and ACA marketplace plans to decide standard prior auth requests within 7 calendar days — down from 14 — and expedited requests within 72 hours. Every denial must now come with a specific, actionable reason.

That matters enormously here. If you catch an expiring auth before the rescheduled visit, you can often get a new one back within a week. Catching it after means chasing a retroactive request, which CMS-0057-F doesn't regulate at all and most payers routinely refuse.

One more thing worth knowing: for Medicare Advantage, an approved authorization is valid for the full course of treatment, and plans can't reopen it mid-course. Some "expired auth" denials on MA claims are simply wrong — and appealable.

HNA tracks every auth with expiry alerts built in. Renewed before expiration. Billed with the correct auth number. Always.

How many auths expired in your practice this month? DM us "AUTH."

Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/30/2026

The patient came in for a rash. You also drained an abscess. You billed both. The payer paid one.

Same-day E/M plus procedure is one of the most misunderstood areas in billing — and it cuts both ways.

When you lose money: the visit genuinely involved separate work — a different complaint, its own history, exam, and decision-making — but modifier 25 wasn't appended. The payer assumes the visit was part of the procedure and bundles it. That E/M is gone, and it was legitimately yours.

When you create risk: modifier 25 gets appended by default to every procedure visit. That's a different problem. OIG analysis found roughly 35% of Medicare claims with modifier 25 didn't meet requirements, and it's been an OIG Work Plan target year after year. Anthem, Cigna, and UHC all run automated modifier 25 reviews.

The rule that settles it: a planned, scheduled procedure has no separately billable E/M. If the patient came in for the thing you did, there's no second service to bill.

And this is about to get more expensive. CMS has proposed paying the highest-valued code at 100% and the second at 50% when an E/M with modifier 25 is billed alongside a procedure. The final rule lands in November — and commercial payers historically follow.

HNA applies modifier 25 based on what the documentation actually supports. Payer-specific rules built into the workflow.

DM us "SAMEDAY."

Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/29/2026

Your new provider worked a full eight weeks. Saw 240 patients. Generated zero dollars.

This is the most expensive mistake a growing practice makes, and it's entirely avoidable.

Here's the timeline nobody plans for. In 2026, commercial payer credentialing runs 90 to 150 days. Medicare takes 60 to 90 through PECOS. Medicaid ranges from 30 to 180+ depending on the state. But the new provider's start date was set by HR, not by the payer.

Every encounter in that gap is a denial.

And the backup plan most practices assume exists? It doesn't:

Retroactive billing is narrow. Medicare allows up to 30 days before the effective date — and the effective date is the later of your filing date or the first date of service. File late, and those months are simply gone.
Most commercial payers don't backdate at all. A few will set the effective date to your submission date, but only if you submitted before the provider's first patient.
Billing under another provider's NPI is not a workaround. Incident-to and locum tenens have narrow, specific requirements, and none of them cover a new hire waiting on credentialing.

One provider, 30 patients a week, 8-week gap, $150 average — $36,000 gone.

HNA starts credentialing before your provider's first day. Full CAQH setup, payer enrollment, status tracking. Zero billing gaps.

Hiring? DM us "CRED."

Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/28/2026

The patient handed your front desk two insurance cards. Whichever one got entered first became "primary." That guess just cost you 60 days.

Coordination of benefits denials — CO-22 on your remit — don't happen because of bad coding. They happen because of bad information. The claim was clean. It just went to the wrong payer first.

And the rules are genuinely complicated:

🔹 Medicare isn't automatically primary. It depends on whether the patient is still actively working and how large the employer is — not their age.
🔹 For children covered by both parents, the birthday rule decides.
🔹 Medicaid is always last.
🔹 A patient who retired last month just flipped their entire COB order, and nobody told you.

Here's what makes this denial type worth fixing first: roughly 70% of COB denials get paid once corrected and resubmitted. The money is fully recoverable. But 65% of denials overall are never reworked at all — so it sits in AR, ages past 90 days, and quietly becomes a write-off.

Sometimes the practice did everything right and the payer simply has a stale COB record on file. That one can't be fixed by billing harder — it takes a call.

HNA verifies COB order at every eligibility check, before the encounter. Primary billed first. Secondary billed with the primary EOB attached. Every time. ✅

Do you know the COB order for every dual-insured patient? DM us "COB."

📅 Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/23/2026

⚠️ You examined the patient. You made the call. You documented it. Then a payer's reviewer, who never saw them, decided it wasn't necessary.

Medical necessity denials are the single most appealed denial type in the country — and here's what makes them different from every other denial: they're usually winnable.

Federal audit data shows payers overturn the majority of their own medical necessity denials once a real appeal is filed. Analysis of ACA marketplace appeals has found overturn rates north of 80%. The money isn't gone. It's just waiting for someone to fight for it.

So why does so much of it vanish? Two reasons. 📋

First, documentation. The coding can be perfectly correct and still get denied if the note doesn't connect the diagnosis to the service in the way the payer's policy requires. Medicare has LCDs and NCDs. Commercial plans have their own clinical policies. They are not the same, and they change.

Second, the clock. Appeal windows vary wildly — Original Medicare allows 120 days, Medicare Advantage often just 60, most ACA commercial plans at least 180. Miss the one printed on your denial letter and the claim is finished.

HNA matches every diagnosis to payer-specific coverage policy before billing. Denials that slip through get appealed with clinical documentation — fast. ✅

Hit with necessity denials this month? DM us "DENIED."

📅 Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/22/2026

🧩 You did the work. You documented it. The payer paid for less than you performed.

Bundling is where payers apply automated edits that collapse multiple CPT codes into one payment. Some bundles are legitimate. Many aren't. The problem is that most practices can't tell the difference, so they either lose money they earned or appeal things they shouldn't.

Here's where real revenue gets left behind:

🔹 Two different joints injected in the same visit. The second injection needs modifier 59 or XS plus laterality. Without it, the edit collapses both into one payment.

🔹 A separate problem addressed during a procedure visit. The E/M is payable, but only with modifier 25 and documentation showing genuinely separate work.

🔹 Ultrasound-guided injections billed as unguided. When guidance is documented with a saved image, the correct code is 20611, which pays roughly $80–$110 more at Medicare rates than 20610. Practices with incomplete imaging documentation default to the lower code every time.

And the flip side matters just as much: slapping modifier 59 on everything to "beat" the edit is one of the fastest ways to trigger an audit. 💸

HNA's certified coders apply the right modifier, on the right line, with the right documentation, before the claim ever goes out. We know every edit. We code correctly. 800+ practices, 99% first-pass rate. ✅

Is your practice leaving money in payer bundles? DM us "CODES."

📅 Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/21/2026

Your payer is paying you LESS than you billed — and sending an EOB that makes it look completely correct. 👀

You bill 99215. They pay 99213.

2026 Medicare rates:
99215 → $192.39
99213 → $95.19
Gap → ~$97 per visit 💸

The claim isn't denied. It's "paid." So it never hits a denial queue, never gets worked, never gets appealed.

Silent. Automatic. Every visit.

HNA audits every EOB against your submitted codes. Downcodes get appealed. Every dollar accounted for.

When did you last audit your EOBs?
DM "AUDIT" 👇
📅 hnabusinessgroupmd.com/schedule-demo

09/18/2026

🧮 Grab a calculator. This takes 30 seconds and it will change how you look at your billing.

Equation 1: Your monthly billed × 20% = what's leaking out.

Bill $50,000/month? That's $10,000 gone. $120,000 a year.
Bill $200,000/month? That's $40,000 gone. $480,000 a year.

Now, is 20% real? Here's what the data says. A survey by Sage Growth Partners and Fibroblast found more than 40% of healthcare organizations lose 10% or more of annual revenue to leakage — and 19% lose over 20%. Research published in JAMA puts the cost of billing mistakes as high as 15–20% of possible income. 📉

It's never one big loss. It's denials nobody reworked — 60–65% never get appealed. It's AR that quietly crossed 90 days. It's underpayments that posted as "paid" and never got audited. Individually small. Collectively, a fifth of your practice.

Equation 2: Same billing + HNA = 99% of collectible revenue captured.

That's the gap. Not more patients, not higher fees — just the money you already earned actually arriving.

Run the numbers on your own practice. Then let us audit them for free. $0 setup, 99% first-pass clean claim rate, 800+ practices, 20+ specialties. ✅

📅 Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/16/2026

🚰 You billed $100,000 last month. How much actually landed in the bank?

For most practices, the honest answer is somewhere near $62,000 — and nobody can tell you exactly where the other $38,000 went. Because revenue doesn't disappear in one place. It leaks in five.

Here's the pipeline, leak by leak:

🔻 Coding errors — $7K. Wrong code, missing modifier, insufficient specificity. Preventable before submission.

🔻 Missing auth — $5K. Roughly 27% of denials start at the front end: eligibility not checked, prior auth not obtained, referral not on file.

🔻 Claim denied — $9K. The national initial denial rate hit 11.6% in 2025 — and research shows 90% of denials are preventable.

🔻 AR 90+ days — $11K. Healthy practices keep AR over 90 days at 18–22% of total. Most never measure it.

🔻 Silent underpay — $6K. Paid claims that came in below contract. No alert, no flag, no queue.

And here's the part that stings: 60–65% of denied claims are never reworked at all. That's not a payer problem. That's a follow-up problem.

HNA seals the pipeline. Every denial appealed. Every underpayment caught. Every claim worked to paid. 99% first-pass rate across 800+ practices. ✅

📅 Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

09/15/2026

💰 "We do billing in-house, so it doesn't really cost us anything."

Let's actually add it up.

Your billing specialist's salary is $52,000. That's the number on the payroll report — and it's the only number most owners ever see.

Here's the rest of the receipt:

Benefits + healthcare: $14,000
Billing software: $8,400
Training + certifications: $3,200
Turnover + rehiring: $11,000
Clearinghouse fees: $3,600

That's $92,200 in hard cost before a single claim goes out. And these aren't inflated figures — the Bureau of Labor Statistics puts the median billing specialist wage at $50,250, and benefits and payroll add roughly 20–30% on top of that. Billing staff turnover runs 30–40% annually in this industry. 📉

Then comes the part nobody budgets for: revenue that never arrives. Uncollected claims at 20%. Underpayments that were never audited. AR that aged past 90 days and got written off. For a typical small practice, that's another $90,000 — money you earned and never saw.

Total damage: $182,200 a year.

HNA costs $0 to start. Percentage of collections only. No software bill, no hidden fees, 30-day notice, cancel anytime. We only make money when you get paid.

📅 Schedule your free demo → hnabusinessgroupmd.com/schedule-demo

HNA Business Group MD

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