CombineHealth Blogs

Marc McCauley

Marc McCauley is a seasoned RCM leader with 36 years of experience spanning both payer and provider sides. He spent nearly two decades working with top insurance companies before moving to provider organizations, where he led teams managing prior authorizations and denials.

Latest news & articles by Author

How to Interpret an Electronic Remittance Advice (ERA) in Medical Billing

Understand the step-by-step process of interpreting an ERA. Explore how to use this information to guide your next steps in the denial management process.

Automated Insurance Verification: Why Hospitals Should Move On From Manual Methods

Manual insurance verification leads to errors, denials, and delays. Learn how automated insurance verification improves accuracy, efficiency, and patient trust.

Clinical Documentation Improvement: Building a Successful CDI Program in Healthcare

Learn what clinical documentation improvement is, why it matters, and how to build a successful CDI program to boost RCM, coding accuracy, and revenue.

Healthcare Revenue Cycle Management: Your Blueprint for Fixing Denials and Increasing Collections

A comprehensive healthcare revenue cycle management guide to reduce denials, increase collections, and optimize every stage of the revenue cycle.

Modifiers in Medical Billing: How AI Simplifies Their Use in Revenue Cycle Management

Learn what modifiers in medical billing are (including modifier 25, 59, 26, 76), why they matter for reimbursement, and how AI can simplify modifier management in RCM.

Healthcare Underpayments: What Providers Need To Know About Getting Fair Reimbursements

Learn how healthcare underpayments occur, what causes underpaid insurance claims, and how AI-driven automation can detect and recover revenue in medical billing.

Upcoding And Downcoding: Key Differences, Risks & Prevention

Learn the differences between upcoding and downcoding in medical billing. Understand financial impacts, legal risks, and how AI ensures coding accuracy.

MIPS Healthcare: What It Is, Why It Costs You Money, and How to Implement It Effectively

Discover what MIPS Healthcare is, why it impacts your Medicare reimbursements, and how to implement it effectively to avoid penalties and maximize performance.

Orthopedic Medical Billing Guide: Challenges and Strategies for RCM Teams

Discover how medical billing for orthopedic practices works, the key challenges involved, and strategies RCM teams can use to reduce denials and boost revenue.

Value-Based Care in Healthcare: A Comprehensive Guide

Discover what value-based care in healthcare means, how it compares to fee-for-service, and what it takes to make the transition.

AI Governance in Healthcare: How To Ensure a Safe, Ethical, and Effective AI Implementation for Your Organization

Discover how AI governance helps healthcare organizations reduce risks like bias, errors, and data breaches while improving trust and compliance

How To Appeal an Insurance Claim Denial: A Provider’s Guide

Discover the step-by-step process for appealing denied insurance claims and understand when a corrected claim is better than an appeal.

Common Claim Denial Codes and What They Each Mean

Understand why medical claims are denied by payers, learn the common claim denial codes, and discover how payers communicate these reasons.

8 Tough Questions to Ask While Evaluating an AI RCM Billing and Coding Solution

Wondering which AI RCM billing and coding solution is the right fit for your healthcare organization? Check out this guide to understand the questions you should ask to evaluate a vendor before making the final decision.

Claim Denial 101: Top Reasons You’re Getting Denied and How to Turn It Around

Understand why claim denials happen in healthcare and what to make of the denial codes communicated by payers. Also, explore how AI-powered denial management can help get faster reimbursements and avoid denials altogether.

5 Silent Revenue Killers in Your FQHC Billing Process

FQHCs often lose revenue to hidden gaps in billing and documentation. This post reveals five silent revenue killers in FQHC billing and how AI can help fix them fast.

One Big Beautiful Bill Act: 6 Key Takeaways for FQHCs

Understand the OBBBA’s impact on FQHCs—Medicaid cuts, work requirements, and coverage loss. Adapt by strengthening outreach, improving billing systems, partnering locally, and embracing tech to reduce admin and financial strain.

Medical Billing And Coding Salaries in 2025: What to Expect

Curious about where medical coding and billing salaries are headed in 2025? This post breaks down average pay, top-paying states, growth trends, and what’s impacting compensation.

2025 Buyer’s Guide for CDI Software: Key Features, KPIs, and Selection Tips

Can't make up your mind on which CDI software to invest in? Check out our comprehensive guide to understand the features to look for and the KPIs to track to find the perfect match for your CDI efforts.

What Is Medical Coding, and How AI Medical Coding Can Help Reduce Claim Denials

Understand all about medical coding, its various types, and how it works. Explore how AI medical coding can help reduce denials and increase claim reimbursements.

Independent Interpretation Explained: Why It Matters For Your CDI and How To Get It Right

Independent interpretation is the key to accurate coding and stronger MDM. This blog explains what it is, why it matters, and how getting it right can protect your revenue and clean up your CDI.

A Complete Guide to Clinical Documentation Improvement Software: Workflow, Benefits, and Real-World Use Cases

Think one missing detail won’t hurt your claim? This blog reveals how small documentation gaps can lead to costly claim denials and how AI-powered clinical documentation improvement software can help flag them.

Medical Coding Salary Benchmarks: What Medical Coding Professionals Need to Know in 2025

Medical coding salaries in 2025 are driven by demand for skilled professionals and evolving payer regulations. This guide breaks down current benchmarks, factors affecting pay, and how coders can future-proof their careers.

Medical Coding Audits: Benefits for Healthcare Practices

ICD-10 Explained: A Comprehensive Guide to Medical Coding

‍What is ICD 11? International Classification of Diseases 11th Revision

The Benefits of HCC Coding in Healthcare

Medical Coding for Pediatric Care: Your Practical Guide to Cleaner Claims and Faster Payments

Not sure which medical codes are relevant for pediatric care and how they're different from general coding guidelines? Explore the nuances of pediatric coding in this blog post and get the reference list of codes to be used in different pediatric settings.

CPT Codes For Mental Health Billing

HCPCS Codes: A Complete Guide

Medical Coding for Emergency Rooms: All You Need to Know

Learn how emergency room medical coding works, why accuracy is critical for care and reimbursement, and how AI supports overburdened ER teams.
Medical coding and AI - CombineHealth

Utilizing AI to navigate ever-changing medical coding guidelines | CombineHealth