The Fight for Independent Medicine
Your independence is worth fighting for.
Intelligence, insights, and resources for independent medical practices navigating corporate consolidation, prior authorization battles, and the AI tools that change the equation.
Medicare WISeR Prior Authorization: A Practice Guide
Which 13 services need a decision, the two routes, timelines, what a non-affirmation means, and how your physicians can earn an exemption. Checked against the CMS guide.
Read the guide → Medicare WISeRWISeR in New Jersey: Who Reviews, Where to Send, What to Include
Contacts for the New Jersey WISeR Participant and Novitas, a request checklist, and what to do after a non-affirmation.
Read the guide → Medicare WISeREpidural Steroid Injections Under WISeR: The Documentation Checklist
The seven things the CMS guide asks to see for an ESI request, the gaps that cause non-affirmations, and how to check before you send.
Read the guide →The Prior Authorization Epidemic: How It's Being Used as a Weapon Against Independent Medicine
Prior authorization was designed as a cost control mechanism. Data shows it has become one of the most effective instruments accelerating the consolidation of independent medicine.
Read article → IPA LeadershipWhy Your IPA Members Are Losing Revenue to Preventable Denials
Most denied prior authorizations are never appealed, and most appeals that are filed succeed. For IPA leaders, the math across your membership is staggering, and the problem is preventable.
Read article → IPA LeadershipWhat Independent Physician Associations Can Do That Corporate Health Systems Can't
The consolidation argument assumes bigger is always better. It isn't. IPAs hold structural advantages that no corporate health system can replicate, and most haven't figured out how to use them yet.
Read article →Why Private Equity Loves Prior Authorization, and What Independent Practices Can Do About It
Prior authorization burden is cited as a top reason physicians sell their practices. That is not a coincidence. Here is the business case corporate consolidators are using, and the AI tools that remove their leverage.
Coming soonThe 15-Point Gap: Why Independent Practices Know Technology Is Their Lifeline, but Don't Have the Right Tools
79% of independent practice leaders say technology is critical to staying independent, yet 41% don't learn about a denied claim for one to two weeks. That gap is costing practices their autonomy, and MedMojo™ exists to close it.
Coming soonYour Independence Is Worth Fighting For: The Case for the Independent Practice Intelligence Platform
Prior auth is where the fight starts. Revenue intelligence, payer contract analysis, compliance monitoring, clinical documentation coaching: the complete AI toolkit that makes independent practice not just viable, but superior to selling.
Coming soonOutsourcing Prior Authorization vs. Automating It: What Practices Should Compare
Outsourcing moves prior auth work to someone else's desk. Automation keeps it in your office. What to compare, including the offshore patient data question.
Read article → Practice OperationsWhat Happens to Your Prior Auths When Your Coordinator Leaves?
When the person who runs prior auth leaves, the knowledge leaves with her. What breaks in the first 30 days, and how to make the queue belong to the practice.
Read article → Prior Authorization Intelligence™The Biologic Burden: Why Independent Dermatologists Are Drowning in Prior Authorization
About 420 prior auth requests per dermatologist per year. Requests up 73.8% in two years while visits rose 2.4%. Here is the cost of the biologic burden, and how AI fights back.
Read article → Prior Authorization Intelligence™How Payers Use AI to Deny Claims Faster, and How to Fight Back
Insurance companies have invested hundreds of millions in AI that denies claims faster than any human can respond. Your billing team is fighting an algorithm with paperwork. Here is how to level the playing field.
Read article →How to Write a Winning Prior Authorization Appeal Letter: Step by Step
A proper denial appeal letter has six components. Most practices send one vague paragraph. Here is the exact structure that moves insurance reviewers toward approval, and the clinical language that wins.
Coming soonThe Appeal Windows Most Practices Miss, and the Revenue They Forfeit Forever
Miss your appeal deadline and the revenue is gone permanently. Here are the exact appeal windows for every major payer, and the alert system that ensures your team never forfeits another claim.
Coming soonPeer-to-Peer Review: The Secret Weapon Most Billing Coordinators Don't Know Exists
When a prior auth is denied your physician has the right to speak directly with the insurance company's medical reviewer. It can reverse a denial before a formal appeal is ever filed.
Coming soon5 Reasons Your Prior Auth Appeals Keep Getting Denied
Most denied appeals fail for the same five reasons. None of them are clinical. All of them are fixable, if you know what insurance reviewers are actually looking for when they evaluate your appeal.
Read article →Prior Authorization for Rheumatology Practices: Why Biologics Are Your Biggest Battle
Every biologic prescription (Humira, Enbrel, Remicade) is a prior auth battle. Here is the clinical documentation strategy that wins approvals and reverses denials for rheumatology practices.
Coming soonWhat CMS-0057 Means for Independent Practices in 2027
The federal government mandated that payers implement FHIR APIs for prior authorization by January 2027. Here is what changes for independent practices, and what the regulation does not fix.
Coming soon