Home › View all posts by Healthcare Leaders of San Antonio › Page 2

Author: Healthcare Leaders of San Antonio

Empowering Wellness: A Guide to Funding Your Healthcare Business through a CDFI

Posted on by

For many healthcare entrepreneurs, the bridge between a visionary medical concept or a functioning practice is paved with capital. Whether you are launching a specialized physical therapy clinic, expanding a home health agency, or modernizing a neighborhood dental office, the traditional banking world can often feel inaccessible. High entry costs, the “startup” label, or a lack of extensive credit history frequently lead to “no” from big-box lenders.

a non-profit Community Development Financial Institution (CDFI), operates on the belief that access to capital should not be the barrier to success. For small healthcare businesses, a CDFI offers more than just a loan; it provides a financial lifeline designed to foster community health and economic growth.

What is a CDFI?

While banks focus on minimizing risk through rigid algorithms, a CDFI focuses on the potential of the entrepreneur. They specialize in providing credit to small business owners who may not meet the strict requirements of traditional commercial sources.

For the healthcare sector, this means a CDFI is a prime candidate for funding micro-practices, medical startups, and underserved health services. They work alongside government agencies and private donors to offer specialized programs that often feature lower interest rates than traditional market products.

What a CDFI Provides: Funding Options for Healthcare

A CDFI’s product suite is versatile, catering to the unique overhead demands of the healthcare industry—from expensive diagnostic machinery to essential payroll during the first few months of operation.

  1. Small Business & Microloans

The bread and butter of a CDFI, these loans range from as little as $500 to $250,000. In healthcare, these funds are frequently used for:

  • Working Capital: Covering day-to-day operations, insurance premiums, and licensing fees.
  • Inventory and Supplies: Stocking medical consumables, PPE, or pharmaceutical inventory.
  • Equipment Financing: Purchasing exam tables, X-ray machines, or specialized software for Electronic Health Records (EHR).
  1. SBA 504 Loans

For established healthcare businesses looking to stop renting and start owning, a CDFI offers SBA 504 loans. These are designed for major fixed assets. If you are looking to purchase a permanent medical office or build a new clinic from the ground up, this program provides:

  • Long-term, fixed-rate financing.
  • Lower down payments (typically 10-15%).
  • Loan amounts that can go up into the millions.
  1. Special Programs & 0% Interest Loans

A CDFI frequently partners with specific cities (like San Antonio, Houston, or Laredo) to offer 0% or low-interest loan programs. These are often targeted at businesses that commit to job creation—a perfect fit for a growing clinic looking to hire its first nurse or administrative assistant.

What Your Business Needs to Provide: The Path to approval

While a CDFI is more flexible than a bank, they are still responsible lenders. To obtain a loan, your healthcare business must demonstrate a clear plan for repayment and operational stability.

The application Checklist

To get started, you will typically need to provide the following documentation:

  • Identification: a valid government-issued ID (Driver’s License) for all owners.
  • Business Structure: Your Employer Identification Number (EIN) and legal formation documents (LLC, S-Corp, etc.).
  • Financial History:
    • Three months of bank statements (personal and/or business).
    • Tax Returns: Typically the most recent 1–2 years of federal returns.
    • Financial Statements: a current Profit & Loss (P&L) statement and Balance Sheet for existing businesses.
  • a Solid Business Plan: Especially for startups, you must provide a detailed narrative of how the business will generate revenue and a breakdown of how the loan funds will be used.
  • Collateral: Most CDFI loans require collateral. In healthcare, this often includes a lien on the equipment being purchased or other business assets.

Eligibility Criteria

  • Age: You must be at least 21 years old.
  • Credit History: While they do not require a “perfect” score, you should be able to show at least 6 months of positive credit history and be in good standing with other creditors.
  • Industry: Most healthcare services are eligible, though certain “speculative” or “passive” businesses may be excluded.

The ” CDFI advantage”: Beyond the Money

What sets a CDFI apart for the healthcare entrepreneur is the Technical assistance. They understand that a doctor or therapist is an expert in their field, but might be new to “running a business.”

When you take a loan from a CDFI, you gain access to:

  • Business Coaching: One-on-one consultations to help with financial management.
  • Workshops: Training on everything from digital marketing for your clinic to mastering QuickBooks.
  • Community: a network of fellow entrepreneurs and mentors who understand the local economic landscape.

How to Get Started

Applying for funding through a CDFI is designed to be efficient, often taking only about 20 minutes to complete the initial application. Once all documents are submitted, the average time to fund can be as fast as 3–5 business days.

If you are ready to take your healthcare business to the next level but the traditional banks have left you feeling stranded, I can help, I can assist  you through the whole process from drafting a business plan summary, to reviewing your qualifications and matching your needs with a specific CDFI .

Contact me today, the sooner you start, the sooner your funding could be available to help your business grow.

August Trevino
Fractional Executive
Commercial Strategist
Direct: (210) 951-9268
e-Mail: au.ent9@gmail.com
Webpage: https://www.linkedin.com/in/acttoday/

Healthcare Leaders Spotlights San Antonio-based MR3 Health

Posted on by

Over the years, one of the most gratifying aspects of our monthly networking events has been learning about new San Antonio-based companies and meeting the visionary entrepreneurs behind them. San Antonians are justly proud of our city’s reputation for innovation and leadership in the healthcare industry so occasionally we like to highlight and celebrate these companies. This month, we shine our spotlight on MR3 Health.

MR3 Health is an innovative remote patient monitoring company focused on preventing the costly and life-altering complications associated with the foot ulcers associated with diabetic neuropathy. And, as most of us are aware, both the San Antonio and South Texas population in general have an unusually high prevalence of diabetes. The company integrates advanced medical devices, daily monitoring protocols and clinical oversight to identify early physiologic changes before they can escalate into acute events.

The company’s flagship monitoring device, TempTouch™, was likewise developed here in San Antonio by a distinguished group of local clinicians and engineers. An FDA-cleared dermal thermometer, the efficacy of the device was clinically proven in the field in partnership with the Veterans Health System and additional researchers associated with the University of Texas at San Antonio Health Science Center. Results of the clinical trials were documented in three peer-reviewed journal articles available on the company’s website. The company possesses proprietary patient management software and maintains a number of strategic industry partnerships that position it, according to MR3 president, Stan Marrett, as a credible and scalable partner for podiatrists, physician practices and health systems.

Given the ongoing prevalence of diabetes, the toll in human suffering in terms of repeated surgeries and amputations, and the staggering medical costs, estimated to be in the billions, that could be prevented by preventive monitoring for the range of chronic conditions including, not only diabetes, but hypertension and COPD as well, MR3’s business model and mission align closely with national public health priorities.

Another example of a San Antonio company helping people while setting the pace for its competition.

Commercial Leaseback as a Strategic Funding Tool in Healthcare

Posted on by

Healthcare organizations operate in one of the most capital-intensive industries in the economy. Hospitals, outpatient centers, physician groups, imaging facilities, hospice, senior care etc, must continually invest in high-cost equipment, technology, and compliance—all while managing reimbursement pressures, labor, and regulatory complexity. In this environment, access to flexible, non-dilutive capital is critical.

One increasingly attractive funding strategy is the commercial leaseback, a structure that allows healthcare providers to unlock capital tied up in owned real estate or equipment without interrupting operations. When used strategically, leasebacks can improve liquidity, strengthen balance sheets, and support long-term growth.

What Is a Commercial Leaseback?

A commercial leaseback (often called a sale-leaseback) is a transaction in which a company sells an owned asset to an investor and simultaneously leases it back for continued use. The seller becomes the tenant, while the buyer becomes the landlord or equipment lessor.

Leasebacks can involve:

  • Commercial real estate (hospitals, medical office buildings, surgery centers, labs)
  • Healthcare equipment (imaging systems, surgical equipment, diagnostic devices, IT infrastructure)

From the provider’s perspective, the transaction converts an illiquid, fixed asset into immediate cash while preserving full operational control of the facility or equipment.

Why Leasebacks Are Particularly Relevant in Healthcare

Healthcare providers often hold a disproportionate amount of capital in non-earning assets. A hospital campus, imaging center, or fleet of high-value equipment may be essential to operations but does not directly generate financial returns in the way clinical services do.

Leasebacks address several structural challenges common in healthcare:

  1. Capital constraints – Traditional bank financing may be limited, slow, or restrictive.
  2. Reimbursement pressure – Cash flow volatility makes liquidity critical.
  3. Rapid technology cycles – Equipment becomes obsolete faster than real estate depreciates.
  4. Growth demands – Expansion, acquisitions, and service line investments require capital.
  5. Balance sheet optimization – Asset-heavy balance sheets can limit strategic flexibility.

By monetizing owned assets, healthcare organizations can redeploy capital into patient care, growth initiatives, and operational improvements.

Real Estate Leasebacks in Healthcare

Common Asset Types

  • Acute-care hospitals
  • Medical office buildings (MOBs)
  • Ambulatory surgery centers (ASCs)
  • Imaging centers
  • Behavioral health facilities
  • Specialty clinics and labs

In a real estate leaseback, the healthcare provider sells the property to an investor—often a healthcare-focused real estate fund or REIT—and signs a long-term lease, typically ranging from 10 to 25 years.

Benefits of Real Estate Leasebacks

Immediate liquidity
The transaction can free millions (or tens of millions) of dollars in capital that was previously tied up in bricks and mortar.

Operational continuity
Providers continue operating in the same facility with no disruption to patient care, staff, or branding.

Predictable occupancy costs
Long-term leases provide rent certainty, aiding budgeting and financial planning.

Risk transfer
Ownership risks such as market value fluctuations, structural obsolescence, and certain capital expenditures may shift to the investor, depending on lease terms.

Strategic focus
Management can focus on clinical outcomes and growth rather than property ownership.

Considerations and Trade-Offs

  • Lease terms may include escalators tied to inflation or fixed annual increases.
  • Some leases are triple-net (NNN), meaning the tenant remains responsible for taxes, insurance, and maintenance.
  • Selling real estate reduces balance sheet assets, which may affect certain financial ratios.

For many healthcare providers, these trade-offs are acceptable when weighed against the liquidity and strategic flexibility gained.

Equipment Leasebacks in Healthcare

In addition to real estate, healthcare organizations often own millions of dollars in equipment—much of it rapidly depreciating but mission-critical.

Common Equipment Eligible for Leaseback

  • MRI, CT, PET scanners
  • Linear accelerators
  • Surgical robots
  • Cath lab equipment
  • Laboratory and diagnostic systems
  • IT and data center infrastructure

An equipment leaseback involves selling owned equipment to a lessor and leasing it back under fixed terms, often aligned with the useful life of the asset.

Why Equipment Leasebacks Make Sense

Unlocks trapped capital
Many providers own equipment outright that no longer supports financing but still holds significant market value.

Preserves clinical capability
Providers continue using the same equipment without interruption or retraining.

Aligns cost with usage
Lease payments spread the cost of equipment over time, matching expenses to revenue generation.

Supports technology refresh cycles
Lease structures can include upgrade or replacement options, helping providers avoid technological obsolescence.

Alternative to debt
Equipment leasebacks may be off-balance-sheet or treated differently than traditional loans, depending on accounting standards and structure.

Strategic Uses of Leaseback Capital in Healthcare

Healthcare organizations commonly use leaseback proceeds to:

  • Fund expansions or new service lines
  • Acquire physician practices or ambulatory centers
  • Invest in digital health, EHRs, and cybersecurity
  • Reduce higher-cost debt
  • Stabilize working capital during reimbursement delays
  • Support turnaround or restructuring initiatives

Unlike equity financing, leasebacks do not dilute ownership or governance control—an important consideration for physician-owned groups and nonprofit systems.

Regulatory and Compliance Considerations

In healthcare, leasebacks must be structured carefully to comply with applicable regulations, including:

  • Stark Law
  • Anti-Kickback Statute
  • Fair Market Value (FMV) requirements
  • Commercial reasonableness standards

Lease terms must reflect market rates and legitimate business purposes. Working with experienced healthcare legal counsel and specialized investors is essential to avoid compliance risk.

Who Uses Healthcare Leasebacks?

Leasebacks are used across the healthcare spectrum, including:

  • Independent physician groups
  • Multi-site specialty practices
  • Ambulatory surgery center operators
  • Regional hospital systems
  • Behavioral health and post-acute providers
  • Private equity-backed healthcare platforms

They are particularly valuable for organizations in growth mode or those seeking balance sheet flexibility without taking on additional traditional debt.

Conclusion

Commercial leasebacks—covering both real estate and equipment—represent a powerful but underutilized funding strategy in healthcare. By converting owned assets into liquid capital, providers can strengthen financial resilience, support growth, and focus on their core mission: delivering high-quality patient care.

In an industry facing constant change and capital pressure, leasebacks are not merely a financing tool—they are a strategic option for healthcare organizations seeking flexibility, stability, and long-term sustainability.

 

If you would like to discuss Lease Sale back in reference to your business, please Contact

August Trevino
Direct: ‪(210) 951-9268
e-Mail: au.ent9@gmail.com

 

August Trevino
Fractional Executive
Commercial Strategist
Direct: (210) 951-9268
e-Mail: au.ent9@gmail.com
Webpage: https://www.linkedin.com/in/acttoday/

 

Right Health Systems hosts DreamHealth: Community Health Fair

Posted on by

Right Health Systems is proud to host the upcoming Dreamhealth: Community Health Fair, a collaborative initiative created to improve access to quality healthcare resources while promoting education, prevention, and overall well-being within our community. Phoenix Management International is honored to support and promote the DreamHealth initiative, a cornerstone of the annual DreamWeek San Antonio Summit. This initiative unites healthcare providers, wellness advocates, local businesses, educational institutions, and community-focused organizations around a shared mission to expand access to essential health resources for individuals and families at every stage of life. By bringing services and support directly to the community, DreamHealth strengthens collective well-being, fosters meaningful collaboration, and advances long-term health equity throughout San Antonio and surrounding communities.

Event Details:
Date: January 24, 2026
Time: 12:00 NN – 4:00 PM
Location: San Antonio Botanical Gardens
555 Funston Pl. San Antonio, TX 78209

We invite you to come and join us for an afternoon of connection, education, and community empowerment as we work together to build healthier futures for all.

Add your support as a sponsor! Download the sponsor prospectus here. And then fill out the form to be a sponsor, or an exhibitor, here!

Right Health Systems, a 501(c), licensed health care system forged on the pillars of
Advocacy, Collaboration, and Education. EIN: 39-4092536
RIGHT HEALTH SYSTEMS:
MARQUEE COMMUNITY HEALTH FAIR
A Dreamhealth feature

 

 

Medical Funding for Service and Healthcare Providers.

Posted on by

12/2025 By August Trevino commercial strategist

Introduction:

Nature of Transaction: Funding is a debt (a loan), while factoring is considered the sale of an asset.

 Medical Receivable funding (MRF) is designed as a quick funding solution for service companies that bill healthcare providers directly. Examples would be staffing, transcription, hospice, supplies/devices, etc.

Medical factoring (MF) is designed as a quick funding solution for healthcare providers that bill insurance directly (Insurance Companies, Medicare/Medicaid, etc.). Examples would be physician medical practices, hospitals, rehabilitation centers, nursing / assisted living facilities, etc.

Let’s start with Medical Receivable Funding. (MRF) has emerged as a vital financial tool for service companies that bill healthcare providers directly. In industries where cash flow is often strained by delayed reimbursements, MRF offers a streamlined solution to bridge the gap between invoicing and payment.

The challenge of delayed working with payments for healthcare providers, including hospitals, clinics, and long-term  care facilities, is that they operate within complex reimbursement structures. Payments may be delayed due to insurance verification, compliance checks, or administrative bottlenecks. For service companies that support these providers, such delays can create significant financial stress. Payroll obligations, vendor payments, and operational expenses continue regardless of when invoices are settled. Without reliable cash flow, even well-established businesses can struggle to maintain stability.

MRF is designed to address this challenge by converting outstanding receivables into immediate cash. Instead of waiting weeks or months for healthcare providers to pay invoices, service companies can sell or finance their receivables through specialized funding firms. These firms advance a percentage of the invoice value—often within 24 to 48 hours—providing the company with quick liquidity. Once the healthcare provider pays the invoice, the funding firm collects repayment, deducts its fees, and remits any remaining balance to the service company. This process is similar to commercial factoring but tailored specifically to the healthcare ecosystem. By focusing on receivables tied to medical providers, MRF firms understand the unique payment cycles and compliance requirements of the industry.

The advantages of MRF are multifaceted:

  • Immediate Cash Flow: Companies gain access to funds quickly, ensuring they can cover payroll, purchase supplies, and manage day-to-day operations without disruption.
  • Operational Stability: Predictable funding allows businesses to plan growth strategies, expand services, and invest in new technologies.
  • Reduced Financial Stress: By eliminating the uncertainty of delayed payments, MRF helps companies focus on service delivery rather than collections.

This next section deals with medical factoring (MF).

Healthcare providers operate in a financial environment unlike most other industries. Physician practices, hospitals, rehabilitation centers, and nursing or assisted living facilities often deliver services upfront but must wait weeks—or even months—for reimbursement from insurance companies, Medicare, or Medicaid. This lag in payment can create significant cash flow challenges. Medical factoring (MF) has emerged as a practical solution, offering immediate liquidity by turning receivables into cash.

What Is Medical Factoring?

Medical factoring is a financial transaction in which healthcare providers sell their insurance receivables to a factoring company. Instead of waiting for insurers or government programs to process claims, providers receive a cash advance—often within 24 to 48 hours. The factoring company then collects the payment directly from the insurer when it becomes due. Importantly, this arrangement is not a loan. Funding through traditional debt instruments adds liabilities to the balance sheet, while factoring is considered the sale of an asset. This distinction makes MF an attractive option for providers seeking liquidity without incurring debt.

Why Healthcare Providers Use MF

Healthcare organizations face high operating costs, from payroll and medical supplies to rent and compliance expenses. Delayed reimbursements can disrupt operations, even for financially stable practices. Medical factoring addresses these challenges by:

  • Accelerating cash flow: Providers gain immediate access to funds tied up in insurance claims.
  • Avoiding debt obligations: Factoring does not involve interest payments or loan covenants.
  • Reducing administrative burden: Factoring companies often manage collections, freeing staff to focus on patient care.
  • Supporting growth: Reliable cash flow enables providers to expand services, hire staff, or invest in new equipment.

Who Benefits from Medical Factoring?

Medical factoring is particularly useful for organizations that bill insurance directly. Examples include:

Physician practices: Smaller clinics often struggle with reimbursement delays. Factoring ensures they can cover payroll and operating costs.

  • Hospitals: Large institutions face significant overhead. Factoring stabilizes cash flow during periods of high patient volume.
  • Rehabilitation centers: Extended treatment programs rely heavily on insurance payments. Factoring provides predictable funding.
  • Nursing and assisted living facilities: With ongoing care needs and high staffing costs, these organizations benefit from faster access to receivable funds.

How the Process Works

  1. Claim submission: The provider submits insurance claims as usual.
  2. Sale of receivables: The factoring company purchases the claims, typically advancing 70–90% of their value immediately.
  3. Collection: The factoring company collects payment from the insurer.
  4. Settlement: Once payment is received, the factoring company remits the remaining balance to the provider, minus a small fee.

Advantages and Considerations for these types of funding.

Medical factoring and funding offers clear advantages: speed, flexibility, and reduced financial stress. However, providers should carefully evaluate these companies. Fees vary, and transparency in contract terms is essential. As example disclosures, some companies alter the client that you are factoring and some companies will keep this confidential. While factoring improves cash flow, it does not increase reimbursement rates or eliminate systemic delays in insurance processing. It is always advised to seek advice from a professional with experience in this field.

 

August Trevino

FRACTIONAL EXECUTIVE

COMMERCIAL STRATEGIST 

Direct: ‪(210) 951-9268

e-Mail: au.ent9@gmail.com

Webpage: linkedin.com/in/acttoday

Supporting the Alzheimer’s Association in San Antonio

Posted on by

The Alzheimer’s Association is steadfast in its mission to serve the San Antonio community through comprehensive support, cutting-edge research funding, and tireless advocacy for those affected by Alzheimer’s disease and related dementias. This year has marked significant milestones in our local fight against this devastating disease. We’re proud to introduce our first-ever Alzheimer’s Association mobile app, a groundbreaking tool designed to guide individuals and families affected by Alzheimer’s and other dementias directly to the support and education they need to navigate this challenging journey. This innovative resource puts critical information, care strategies, and connection to our services right at users’ fingertips, making it easier than ever to access help whenever and wherever it’s needed.

The passage of Proposition 14 represents a historic victory for Texans impacted by Alzheimer’s, authorizing crucial state funding for research and support services that will strengthen our ability to serve families throughout the San Antonio region. As we close out another successful Walk to End Alzheimer’s fundraising season, we’re deeply grateful to the thousands of participants, volunteers, and donors who join us through the end of the year in raising critical funds and awareness. Funding raised stays local, supporting free care consultations, support groups, educational programs, and our 24/7 Helpline that serves as a lifeline for caregivers navigating the challenges of this disease.

Looking ahead to spring, we’re excited to begin preparations for our signature gala event, which promises to be an elegant evening of community, hope, and fundraising. This celebration will bring together San Antonio’s most dedicated advocates, supporters, and community leaders to honor those we’ve lost, support those currently fighting, and invest in the breakthrough treatments and care solutions of tomorrow.

Whether you participated in this year’s Walk or are looking for ways to get involved, we invite you to join us in building a stronger, more supportive San Antonio for everyone touched by Alzheimer’s disease.

by Valerie Levario

 

Healthcare Leaders is helping support the Poco Loco team for the Walk to End Alzheimer’s and will be collecting donations at our December 11th, 2025 and our January 8th, 2026 networking mixers. If you are unable to join us on those dates, you can still help us support this important cause by scanning the QR code below. Join us in the fight to end Alzheimer’s!

 

Webinar: The RPC Method by Dr. Uejin Kim

Posted on by

Dr. Uejin Kim is a dual board-certified psychiatrist specializing in child, adolescent and adult care. She provides compassionate care by “bridging spirituality and mental health” through her practice, Restore Psychiatry She is a devoted Christian, a compassionate mother and an advocate for mental wellness.

On November 13th, 2025, HLSA was honored to host Dr. Kim as our special guest for a webinar titled, The RPC method: Achieving True Success & Freedom for High Achievers. A perfect topic for many healthcare professionals whose jobs include high-stress, high-responsibility decisions that can leave them feeling drained and overwhelmed, leading to burnout and disconnection. If you missed the life webinar, we hope you can take some time now to watch as Dr. Kim discusses techniques for learning to pause in your busy work schedule without self-judgment, how to protect your energy, and how to reconnect with purpose- transforming stress into resilience.

 

AI for Work and Life

Posted on by

AI has been under development for decades.  Recently, AI has taken a hockey stick trajectory into the mainstream with the development of new and ever evolving AI tools.  At 67 years old, I have not been the most informed on technology over the years.  As I speak with others at our HLSA Networking events I KNOW there are useful and evolving benefits for AI.   But many have a self-imposed roadblock on learning new technology.

Whether you are just starting your career or if you are a seasoned executive there will be a place in your toolbox for AI which will enhance your career or just assist you in becoming more efficient and familiar with the technology and its tools.

As a result of my shortcomings in technology I decided to become more familiarized with AI and its current development.  I did so by enrolling in a free certificate course from the University of North Florida (UNF). The course is currently free for a limited time thanks to NLP Logix who has sponsored the program.

This program is designed to help professionals, students and lifelong learners understand and apply Artificial Intelligence in practical, everyday contexts – both in the workplace and beyond. The program is fully online and consisted of 8, self-paced modules with an approximate 10-hour duration total timeline.

I started Module 1 on October 23rd and completed Module 8 and received my certificate on November 16th.  The Course was facilitated by various experts and leaders in AI development in a number of various platforms.

The introduction to AI was the catalyst for starting the program and was interesting and thought provoking.  It fueled my ambition to learn more. The course then moved onto highlighting a number of AI Tools, how to use them and incorporated a demonstration on how these tools can be accessed and utilized for your work or life benefits.

In my opinion, the module on the Art and Science of Prompting was the most valuable as this is the key to getting your desired results from any AI tool.  The program then progressed into the rising ethical challenges that AI brings.  Narrow AI vs Large Language Models (LLMs) were discussed along with the pitfalls of each.  AI is not perfect so there are necessary guidelines you need to know about when engaging with AI tools.

The program then addressed AI in key industries such as Medicine, Law and everyday life and progressed into how AI has and may affect our world as it continuously develops and evolves.  The material covered make me think about the possibilities and cemented my decision to take this valuable beginner’s course.

I can enhance my newly gained knowledge further by engaging further with the utilization of AI tools and learning how to make AI enhance my work & everyday life.  Jumping in and utilizing various AI tools will ultimately determine the extent of knowledge I will gain.  I would suggest that any beginning student or seasoned executive with limited knowledge take a beginner’s course which may possibly inspire you by going into deeper context through the many programs that are developing on the Topic of Artificial Intelligence.

 

by Gary Meyn, LFACHE

 

 

Navigating the Complexities of Medical Billing: Coding Errors and Medicare Denials

Posted on by

Medical billing remains one of the most persistent administrative challenges for physicians. Coding errors and the high rate of Medicare claims denials are among the top perennial issues—and both can significantly impact practice revenue and operational efficiency.

Coding errors, whether due to outdated codes, misinterpretation of clinical documentation, or simple clerical mistakes, are a leading cause of claim rejections. Due in no small part to the complex and changing nature of the code sets. The ICD-10  updates for FY2025, for example, included 252 new codes, 36 code deletions, and 13 code revisions. These changes, along with the similarly evolving CPT codes, require ongoing education and rigorous attention to detail. Even minor discrepancies—such as mismatched procedure and diagnosis codes—can trigger denials, delay payments, or invite audits.

The need for vigilance in billing and coding is nowhere more apparent than with Medicare, the largest payer in the U.S. healthcare system. According to recent data, average Medicare denial rates for physicians can range from 5% to 10%, depending on specialty and region. Common reasons include insufficient documentation, incorrect modifiers, and lack of medical necessity. These denials not only reduce cash flow but also increase administrative burden, as practices must invest time and resources into appeals and resubmissions.

The financial implications are substantial. Rejected claims can lead to lost revenue, especially if not corrected promptly. Moreover, repeated errors may flag a provider for compliance reviews, adding legal and reputational risks.

To mitigate these challenges, many practices are turning to third-party revenue cycle management companies, certified medical coders, automated billing software, and regular audits. However, even with these tools, the human element remains critical—accurate documentation and clear communication between clinical and billing teams are essential.

In an era of value-based care and tightening reimbursement models effective medical billing skills and solutions are indispensable to sustaining your practice.

 

Editor’s note: We discovered this Linkedin post by Anoop Silva, President of Wave Online, shortly after publishing article and wanted to add it as a postscript because it resonates so closely with the things we hear at our networking events, i.e. less than optimal documentation habits, poor modifier usage and workflow inconsistencies contribute greatly to revenue loss.

Made Lovely by Leslie- A Special Offer for HLSA Members!

Posted on by

We recently had the pleasure of meeting Leslie Reed at one of our monthly business mixers. Leslie is a licensed esthetician and owner of Made Lovely by Leslie Esthetics, a luxury skincare studio located at 18470 Blanco Rd, Suite 111 in Stone Oak. A focused and dynamic business woman herself, Leslie understands what motivates professionals and 0ver 80 percent of her clientele includes professionals like attorneys, executives, and entrepreneurs. As Leslie explains it “I know what it’s like to look in the mirror and want your skin to match how vibrant and successful you feel inside. That’s why I blend advanced skincare science with a relaxing, high-end spa experience — so you don’t have to choose between results and self-care.”

And about that special offer? Leslie is graciously offering our HLSA members a 25 percent discount on one of her treatments!

Who is a HLSA member? If you have ever come to one of our mixers or received our newsletter we consider you a member.

Just contact Leslie and tell her you saw the offer here or in our newsletter.

We know you will enjoy the experience!