Medical Billing Processes

Understanding Variations in Construction Contracts What is a Variation? ✔ A change or modification to the original contract scope, quantity, or specification. ✔ Can be initiated by the Employer, Engineer, or even requested by the Contractor. ✓ Typically involves adjustments in cost, time, or both, requiring approval and documentation. Types of Variations ✔ Changes in Design or Specifications - Alterations to materials, finishes, or structural elements. ✔ Addition or Omission of Work - Extra work requested by the Employer or removal of unnecessary work. ✔ Changes in Construction Methods - Modifications to improve efficiency, cost, or safety. ✔ Adjustments in Contract Duration - Time extensions due to scope increases. Variation Approval & Implementation Process 1 The Employer or Engineer initiates a variation order (VO) when changes are needed. 2 The Contractor submits a cost and time impact assessment for approval. 3 The Engineer reviews, negotiates, and issues a variation instruction if approved. 4 The variation is incorporated into the contract, and the changes are reflected in Interim Payment Applications (IPA). Impact on Interim Payment Certificates (IPC) ▲ Variations can significantly affect monthly IPCs, as they alter measured work quantities and contract value. Proper documentation and approvals are essential to ensure fair payments and avoid disputes. 17 Key FIDIC Conditions for Variations ✔Variations must be approved and instructed by the Engineer before execution. The Contractor must submit cost/time impact claims within the timeframe set in the contract. Unapproved variations may lead to non-payment or disputes. Changes must be reflected in subsequent Interim Payment Applications (IPA) and IPCs. Why It Matters? Managing variations effectively ensures project efficiency, cost control, and contractual compliance. Stay Connected! My next article will cover Flexuation in Construction Projects+ #Quantity Surveying #Variations #Construction Contracts #ContractAdministration #CostControl #ConstructionIndustry#ProjectManagement

Claims and Change Orders | 28 NOV 2024 - What exactly is a "#Claim" in the world of #contract #management? As someone who just completed a course on managing change orders and contractual claims in Meirc Training & Consulting, let me shed some light. A claim is a formal request based on the right to #remedy in the contract or general #law. Changes and claims are expected and inevitable thus, could be for additional time or money due to directed, constructive and cardinal changes. But claims are not just about the numbers. They're about advocating for your project, your team, your vision. Navigating claims skillfully is crucial to deliver change successfully.  Here are the 7 key principles of handling contractual claims 1. Timing Act swiftly to initiate notice to claim within 28 days (#FIDIC), document and submit your claim before deadlines slip by. Fully detailed claim to be submitted within 42 days of event (or other agreed time). 2. Documentation Documentation is the backbone of a bulletproof claim. Leave no paper trail unturned. Be meticulous with records and include exhibits (letters, minutes, notice), baseline schedule, delay analysis, cost calculations and drawings. 3. State your demands clearly Quantify the impact by including a clear dollar value on the #costs and #delays for all incurred expenditure plus overheads. Costs may include prolongation, equipment, office overhead, field operation and loss of profit costs. 4. Know your contract Anchor your claim firmly in the terms you both signed up to. Time-related changes may be linked to #excusable delay, #force #majeure clause while cost related claims may be linked to #variation #additional works or #suspension clauses. 5. Negotiate in good faith Seek a fair compromise - your goal is a #win-win, not total victory. Always seek to resolve claims, differences and #disputes in the least formal and #collaborative manner possible. Legal proceedings have consequences. 6. Tell a compelling story Frame the claim as a mutually beneficial resolution, not an adversarial demand. Do not use legal and complicated language. Suggested presentation of a claim includes; Executive summary, Statement of claim, Cause & Effect Analysis, Entitlement and Conclusion. 7. Stay professional, not personal Stick to the facts and resist the urge to assign blame. Provide brief history, state facts, detail breach (be clear and specific). Demand a response and specify due date within 42 days (#FIDIC). Mastering these principles can mean the difference between a claim that gets approved, and one that gets dismissed. So the next time you're facing a roadblock, don't just accept it. Craft your claim, make your case, and keep your change moving! #CIPS - The Chartered Institute of Procurement & Supply #knowledgesharing cc: Anastasia | Lana | Alaa

One of the worst feelings working on contracts is when you knowingly sign a terrible contract. You may have no leverage and be stuck with the counterparty's standard terms. You may be doing a deal with a counterparty only willing to move forward on one-sided terms. Of course, you can always choose to walk away and not sign. That's what most lawyers will advise because doing no deal is often better than doing a bad deal. But sometimes companies make a risk decision that doing no deal in this case is a worse outcome than signing a bad deal. While you may be stuck without typical contractual protections and options, there may be things you can do before and after you sign the contract to protect the company. 1. Try to shorten the term of the agreement – Signing unfavorable contracts is risky, but it becomes much riskier when you are locked in for a longer term. Try to reduce the term to your minimum viable length that still makes it worthwhile to preserve other options if things turn out as you fear. 2. Shift what you can to the statement of work or order form – Moving concepts to the statement of work (SOW) or order form may make it easier to make changes during the term. Most companies have less review and scrutiny over those changes. Your relationship lead at the counterparty may be able to make adjustments that you wouldn’t get through as a formal amendment. 3. Reduce the purchase scope even if it leads to a higher price – See if you can reduce the minimum purchase quantity or feature set, even if it means paying more per unit or hour. Think of that additional per-unit fee as a risk premium. It may give you options to reduce the amount of damage or loss you face from the deal if things go sideways. 4. If payment terms are the problem, talk to Finance about the best strategy – If the payment terms are onerous or have severe consequences for any delay, have a conversation with your Finance team. You may be able to reduce that risk with prepayment or extra monitoring to ensure no problems occur. 5. If you are stuck with low liability limits, look into additional insurance or resources – If you are facing low liability limits, explore operational strategies to reduce the risks. These include getting additional insurance, adding more technology to monitor and track, or hiring more people to oversee the work. These things make it easier to stop little problems from becoming big ones. 6. If it is just a bad deal overall, start evaluating other vendors and solutions – Work in parallel to identify alternative paths that might meet your needs. That diligence may clarify available options or your lack of them. You should also consider how to expand your options through operational changes or hiring for specific skillsets. Don’t wait for trouble to happen. Do what you can to reduce your vulnerability before and after entering into a terrible deal. What other advice would you add for dealing with terrible contracts? #Contracts

Denials aren’t rising. They’re being engineered. One theme keeps surfacing across revenue cycle conversations: Payers are no longer just processing claims. They’re strategically controlling outcomes at scale. And AI is accelerating this shift. The industry is seeing: ➡️ More pre-payment scrutiny ➡️ Increased use of automated edits ➡️ More of what I call non-denial "denials" (e.g. downgrades, downcoding) ➡️ Denials that are technically “valid”… but operationally ridiculous This isn’t random. It’s systematic. And it’s exposing a shift for revenue cycle leaders: The payer playbook isn’t being replaced. But it is being augmented reprioritized. Yes - organizations still need to: ➡️ Follow-up on/appeal denials post-adjudication ➡️ Use denial reporting to identify & correct trends ➡️ Track and improve appeal performance ➡️ Stay current on payer rules Those responsibilities remain foundational. But they’re no longer enough on their own. The leaders gaining ground right now are doing 3 things differently: 1️⃣ Predicting rejections and denials before submission (using data patterns, not just historical reports) 2️⃣ Operationalizing payer intelligence (turning policy & rule changes into real-time workflow updates) 3️⃣ Aligning clinical + financial teams earlier (to ensure documentation supports revenue strategy) This isn’t just a technology shift. It’s a strategic shift - boosted by technology. The question is no longer just: “How do we reduce denials?” It’s: “How do we compete with payer algorithms?” What new payer tactics have you seen in 2026? #RevenueCycle #Denials #RCM

One of my clients closes their books with a single journal entry. No deferred revenue spreadsheets. No manual reconciliation. Nothing. They've had zero billing errors since the day they launched. Here's how we built it. I've set up billing infrastructure for a lot of startups at this point. And the story almost always goes the same way. You launch, you throw together invoices in whatever tool is closest, you tell yourself you'll build a real system once things calm down. Things never calm down. Six months later you're migrating to a new platform while your team tries to close the books on a system that was only ever supposed to be temporary. I've watched it play out dozens of times. FieldSpark decided to skip that entire chapter. They came to us as a brand new company under 3Four Labs. Starting completely from scratch. They didn't have a billing system or a finance team on staff. But their founders had already been through the "figure it out later" approach at previous companies and they knew exactly what that costs. They wanted clean, auditable, investor ready financials from their very first close cycle. So we deployed Maxio as their billing platform before they ever sent their first invoice. → What We Built ◾ Automated invoicing across every contract type ◾ QuickBooks Online integration so AR reconciliation runs without anyone touching it ◾ Full collections workflows with automated reminders, escalation triggers, and credit card retries ◾ SaaS metrics dashboards: ARR, MRR, churn, CLTV Everything was live and operational before the first customer was ever charged. Most startups don't think about investor ready dashboards until they're 12 months in, scrambling to pull together numbers for a fundraise. We had FieldSpark's reporting layer ready from month one. That was the whole point for me. → The Results Their leadership walks into every board conversation with full confidence in the numbers. FieldSpark has never had a meeting where someone questioned the accuracy of the financials. Their entire month end close runs through a single consolidated journal entry. Most SaaS companies their size are still maintaining deferred revenue schedules across multiple spreadsheets, updating them manually every month, hoping the formulas hold. FieldSpark has never had to build one of those. And across every single contract since launch: zero billing errors. "We've been more organized and professional for our customers as a result." === If your billing still runs on spreadsheets and manual workarounds, I get it. It works well enough for now. But every month you wait, that eventual migration gets harder and more expensive. You don't have to wait until something breaks to fix it. Maxio is the platform we used to build all of this. If you want investor ready billing infrastructure from day one, check it out here: https://lnkd.in/eTXXBhK8 This post is sponsored by Maxio.

Miranda, Head of Growth at Runna (+1M app users): 'I was on a call chatting through different tax thresholds & I was like… This is just not the life I need to live.' Imagine you've built a super successful app like Runna (millions of runners from +180 countries, growing like crazy, just acquired by Strava)... Then, as their global user base exploded, they faced significant limitations with their app-store-only monetization strategy: - Customer acquisition was becoming costly - Attribution and measurement became very difficult - Waiting on App Store release cycles slowed them down In search of a better way forward, they landed on the Web2App approach: 'A lot of our marketing is app-focused, but we realized by adding web monetization we could reach an entirely new audience.' And like with most apps, Web2App solved these growth challenges (c. acquisition, attribution, speed)... But, it also introduced new, billing & tax compliance responsibilities: - Handling sales tax compliance (in 175 countries!) - Dealing with chargebacks - Processing refunds - Preventing payment fraud - Owning buyer support - Managing delinquent payments In this realm of billing & tax compliance, they had two options: 1. Go with a traditional payment processor, become responsible for all the above billing & tax compliance matters 2. Go with a Merchant of Record model, let Paddle handle all of the billing & tax compliance matters for them After a lengthy search, Runna chose Paddle as their web monetization partner, sold on the Merchant of Record (MoR) model. One joint Runna + Paddle team run & a week of implementation later, Runna team now doesn't have to worry about billing & tax compliance, but they've also seen: - 15% higher retention on the web - Faster pricing, onboarding & checkout experimentation - Unified data & support (w/ RevenueCat + Paddle integration) Best of all, the Merchant of Record model means Runna can focus entirely on product development and customer acquisition, on their mission to make running accessible and enjoyable for everyone. ...while Paddle handles all compliance, invoicing, and tax remittance across their +175 country footprint. Runna, thank you for this awesome partnership and giving us an excuse to make running dad jokes like 'run billing ops' & 'Runna now runs even MoR fast with Paddle'.

A conversation this week with a large health system’s RCM team reminded me of something fundamental: even the most experienced teams are hitting limits they simply can’t hire their way out of anymore. Earlier this week, I was on a call with a major first-party RCM operation inside a health system — a team that has been handling patient financial engagement and collections for over 20 years. And despite all their experience, their story is becoming increasingly common across revenue cycle teams: • They’ve grown their patient collections staff significantly, but still can’t reach most of their patients. • Outreach capacity simply cannot keep up with rising patient volumes. • Attrition is running 20–25%, creating constant performance variability. • They’ve used BPOs for overflow, but service consistency and compliance remain challenges. These are not small issues, they’re structural constraints. So when discussions turn toward Voice AI, it’s not because teams want to replace humans or slash costs. It’s because they’ve reached the ceiling of what traditional staffing models can achieve. The health system we spoke with is adopting Operator Labs Voice AI to: • Scale daily patient outreach instantly • Deliver consistent, compliant financial conversations • Reach patients on time across voice, SMS, and email • Provide a respectful, predictable patient experience with every interaction, every day And what struck me most is this: Outbound outreach is only their starting point. As we walked through their revenue cycle workflows, they identified multiple areas: payment plans, callbacks, follow-ups, pre-service outreach, where automation can help reclaim revenue slipping through the cracks for years. There are tens of billions of dollars in patient balances that go uncollected annually. The real winners won’t be the organizations using AI just to reduce FTEs. They’ll be the organizations that use AI to unlock revenue growth and eliminate the outreach bottlenecks humans simply can’t scale to meet. This health system’s RCM team understands that shift. And we’re seeing this mindset take root across the industry. AI in the revenue cycle is no longer a cost cutter. It’s a revenue unlocker.

Contract managers: Yearly indexation is not a “tick-the-box” exercise anymore. In times of rampant uncertainty, indexation and cost-of-living adjustments (COLA) can either: - Protect continuity and fairness, or - Quietly accelerate value leakage, disputes, and supplier risk. The right thing to do is neither “always accept” nor “always fight.” The right thing to do is to manage indexation as a governance decision. What good looks like (practical, Monday-ready) 1) Start with the contract, not the invoice. Before you react to a price increase letter, answer three questions: - What does the clause actually allow (index, cap, floor, timing, notice)? - What evidence is required (published index, calculation method, base year)? - What happens if you miss the window (automatic adjustment, deemed acceptance)? 2) Separate COLA from performance. Indexation is about macro conditions. Performance is about delivery, quality, and outcomes. If a supplier requests +8% COLA while service levels are slipping, don’t mix the debates. Run two tracks: - Track A: clause-based indexation (objective, auditable) - Track B: performance and value (commercial conversation) 3) Treat “index choice” as a risk decision. CPI, wage indices, sector indices; each tells a different story. Ask: Which index best reflects the supplier’s real cost drivers for this scope? If the index doesn’t match the cost base, you’re not “being tough” you’re being inaccurate. 4) Build a portfolio view (not one-off firefighting). Uncertainty punishes inconsistency. Segment your contracts: - Critical suppliers (continuity first) - Competitive categories (benchmark + negotiate) - Long-tail spend (standardize rules, reduce noise) 5) Document the rationale. The most underrated skill right now: creating an audit trail that a CFO, auditor, or regulator can understand in 2 minutes. Not just “what” you agreed, but “why” it was reasonable. A simple principle I use: Be fair, be consistent, and be fact/evidence-based. That’s how you protect relationships AND protect value.

⏳ Extension of Time (EOT) - Basic Tips Practical & Contract-Driven Insight 🚧 EOT is NOT a favor. It is a contractual right designed to maintain fairness when delays occur beyond the contractor’s reasonable control. In today’s complex construction environment 🏗️ high-rise towers, infrastructure works, fast-track projects delays are inevitable. What truly matters is how delays are identified, documented, and contractually assessed. 🔍 What EOT Really Means An Extension of Time adjusts the contractual completion date when eligible delay events occur. 🎯 Its key objectives are to: 🛡️ Protect contractors from unfair liquidated damages ⚖️ Maintain contractual balance between employer & contractor 📅 Reflect a realistic and achievable project program 🤝 Minimize disputes and adversarial claims 🧾 Common Grounds for EOT Typical delay events that may justify EOT include: 🕒 Delayed approvals, instructions, or design reviews 🔄 Scope changes or additional works 🚪 Late site access or incomplete handover 🌧️ Extreme or abnormal weather conditions 🏛️ Political, regulatory, or economic disruptions 🚢 Global supply chain and material shortages 📌 These events must always be assessed against the approved baseline program and their impact on the critical path. 📝 Notice & Records — Where Most Claims Fail Most standard contracts FIDIC require: ⏱️ Timely notice of delay 📂 Contemporaneous records 🔗 Clear cause-and-effect analysis ❌ Late notices or weak records often result in rejected or reduced EOT claims, even when delays are genuine. 🔀 Concurrent Delays — The Grey Area When employer and contractor delays occur simultaneously: ✔️ EOT may still be granted 💰 Cost entitlement is usually limited or excluded 📖 Assessment depends on dominant cause and contract wording This is where planning expertise + contract knowledge make the difference. 🧠 Final Thought EOT management is not about claims. It is about leadership, transparency, and professional project control. 🚨 Projects don’t fail because of delays. They fail because delays are poorly managed. ♻️ Repost if this added value 🔔 Follow Ahmed Badawy for practical construction & project management insights #EOT #AhmedBadawy

CMS published a valuable and (surprisingly) easy to read fact sheet relevant to anyone in the mid-revenue cycle. Link to “Complying with Medical Record Documentation Requirements” below, along with a handy ACDIS recap. The fact sheet lays out four common sources of denial related to insufficient documentation. CDI, coding, and compliance professionals, take note. The fact sheet summarizes findings from the Comprehensive Error Rate Testing (CERT) program. When CERT requests a review, the billing provider must send supporting documentation (for example, physician’s order or notes to support medical necessity) from a referring physician’s office or from the hospital. That documentation is used to support the justification for the claim, and if it doesn’t, recoupments occur. Last year, Medicare FFS claims had an estimated 7.66% error rate per CERT, accounting for $31.7 billion (B, billion) in improper payments. What were the four most common sources of error? 1.       Evaluation & Management (E/M) Services: CERT identified office visits (established), hospital (initial), and hospital (subsequent) as the top three errors in E/M service categories. High errors included insufficient documentation, medical necessity, and incorrect coding of E/M services to support medical necessity and accurate billing of those services. 2.       Diagnostic Tests: CERT identified there was insufficient documentation to support medical necessity in the plan, or intent to order diagnostic tests. If the handwritten signature is illegible, include a signature log, CMS advises. 3.       Physical Therapy Services: CERT identified the documentation submitted by the physician or NPP didn’t support certification of the plan of care (POC). CERT requires the physician’s or NPP’s signature and date of certification of the POC, or progress note. 4.       Durable Medical Equipment (DME): Hospital beds, glucose monitors, and manual wheelchairs require a written order or prescription from the treating practitioner as a condition for payment, which must meet standard written order requirements. Many apparently did not. Other common sources of error noted in the fact sheet include: ·     Incomplete progress notes (for example, insufficient detail to support providing the service according to coverage requirements) ·     Medical records that fail to demonstrate authenticity or otherwise meet a signature requirement for payment (examples: no provider signature, no supervising signature, illegible signatures without a signature log or attestation to identify the signer) ·     No documentation of order or intent to order services and procedures if required by Medicare policy The ACDIS article below includes some great strategies for beefing up supporting documentation. Check it out. And share the fact sheet with your CDI, coding, and compliance teams. And don’t forget your John Hancock. I’m surprised signatures are still a problem … but there you have it.