The healthcare landscape is evolving quickly. With the passage of the One Big Beautiful Bill (H.R. 1), organizations nationwide are preparing for major changes to Medicaid eligibility, reimbursement requirements, and compliance timelines. As early implementation deadlines arrive in 2026, providers must adapt quickly and strategically to protect revenue and maintain operational stability.
These changes are expected to increase uncompensated care and place greater pressure on front-end eligibility verification. Accurate, real-time verification will be critical to reducing preventable denials and minimizing revenue loss in an increasingly complex regulatory environment.

ZMark Health Revenue Cycle Solutions brings deep expertise in eligibility management, reimbursement integrity, and operational support to help organizations navigate this transition with confidence. Our approach combines technology, proven processes, and hands-on partnership to turn regulatory complexity into manageable, sustainable workflows.

Hear directly from Matt Zabolotny as he explains how ZMark Health helps organizations prepare for these upcoming Medicaid changes.

👉 Watch the discussion to learn more about our approach, or
👉 Download the flyer for additional details on how we support eligibility verification, revenue protection, and regulatory readiness.

The Essential Guide to Improving Copay and Patient Balance Collections in Behavioral Health

Behavioral health organizations today face growing pressure around patient financial responsibility, rising copays and deductibles, and increasingly complex insurance reimbursement rules. Without a strong, compliant collections process, even well‑run practices experience revenue leakage, staff overwhelm, and patient confusion.

This is exactly where ZMark Health can assist. We specialize in behavioral health revenue cycle management (RCM), helping providers implement clear, ethical, and scalable systems for improving copay collection, reducing patient balance aging, and supporting long‑term financial stability.

The Core Principles That Strengthen Collections

Successful behavioral health organizations rely on four foundational elements:

• Transparency: Patients should always understand what they owe, why, and when. Most billing issues stem from confusion—not resistance.
• Consistency: Policies must be applied uniformly across all patients, providers, and visit types to reduce resentment, burnout, and compliance issues.
• Clear Role Boundaries: Clinicians focus on care, while administrative or billing staff handle financial discussions—protecting therapeutic relationships.
• Compassion With Structure: Empathy doesn’t mean avoiding financial conversations. Clear expectations actually reduce anxiety for patients and staff.

Where Collections Are Won or Lost: Intake

Almost all collection challenges begin before the first appointment. Strong intake processes include:

• Insurance eligibility and benefits verification before the visit
• Clear explanation of estimated patient responsibility, including copays and deductibles
• A written financial policy outlining payment expectations and cancellation fees
• Digital or paper acknowledgment to ensure compliance
• Normalizing financial discussions during scheduling and confirmation

When patients understand their financial responsibility upfront, they’re far more likely to pay consistently.

Get the Full Framework

This overview is just the beginning.

Download our Infographic: Financial Clarity Without Compromising Care

• Transparency
• Consistency
• Clear Role Boundaries
• Compassion with Structure
• Compliance insights

Go Deeper with ZMark Health

We are here to help you apply these strategies with confidence. From modernizing front‑end collections to optimizing patient billing workflows, our revenue cycle team helps behavioral health practices improve collections without compromising care.

Download the full PDF now and learn how ZMark Health can support a stronger, more efficient collections model—without ever compromising quality of care.

Starting a physical therapy practice is an exciting venture that requires hard work, dedication, and a solid business plan. Whether you are recently graduated or are an established therapist looking to open a private practice, setting the groundwork for your business is necessary for success. To create a sustainable business, you need to consider everything from choosing a location to determining payment options to obtaining your National Provider (NPI). This guide covers the important considerations for the practice logistics necessary to establish amazing patient care. Our experienced team at ZMark Health is here to guide you through this complex process every step of the way. To ensure a productive kick-off meeting, we invite you to start reflecting on the following items from our checklist:

Geography: Strategic Choices for Your Patients

Practice Locations
Choosing the right location is crucial to your practice’s success. Areas with growing populations or a demographic in need of specialty care will correlate with demand for your services. Establishing your practice near hospitals, gyms, schools, or over-55 communities can create valuable referral opportunities and connections to expand your clientele. Additionally, proximity to referring doctors is an important factor, as many referrals come from physicians who prefer to work with physical therapists located nearby. Finally, don’t overlook practical considerations like public transportation access, parking availability, and ADA accessibility to ensure your location is welcoming and convenient for all patients.

Physical Space
The physical space for your practice should reflect your potential clientele and services. Consider the size and layout needed to accommodate therapy equipment, private treatment rooms, and a reception area if needed. Leasing space with other practitioners could potentially ease financial costs but may limit your growth as a business. Choose space that will allow for additional treatment rooms and more equipment as your practice grows.

Saturation Market
Understanding market saturation is equally important as finding the ideal facility for your practice. Research nearby clinics to determine if existing PT providers in the area could potentially have a corner on the market. A saturated market could require you to review your business plan and consider specializing in your services, so you stand out from other businesses. Offering specialty services such as sports injuries or pediatric therapy could allow your practice to fulfill unmet needs within the community.

Obtaining Your National Provider Identifier (NPI)
As you are working on the brick-and-mortar side of your business, it’s vital to start the free application for obtaining your National Provider Identifier (NPI). As an individual provider, your unique NPI is required if you intend to transmit health information electronically. This unique number issued by the Centers for Medicare and Medicaid Services (CMS) will stay with you throughout your career and will be how you are identified by insurance companies should you establish an electronic billing system and become a credentialed provider. We will briefly discuss both later.

Contracts: Structuring Payment Options

Medicaid
Contracting with Medicaid can make your services accessible to low-income individuals and families. However, Medicaid often reimburses at lower rates than private insurance. Before proceeding with a contract, review the terms carefully to ensure the reimbursement structure aligns with your overall business plan. Research the state-specific requirements for Medicaid providers to better understand the billing and payment process.

Self-Pay
Accepting self-pay patients will provide flexibility and ensure faster payment turnaround. Set clear pricing for self-pay services and offer packages or discounts to make this billing model more appealing. When you have transparent communication about service pricing, it helps build trust and avoid misunderstanding with your patients.

Insurance
Partnering with insurance companies can broaden your patient reach, but there are many steps involved with becoming a contracted provider. Submitting a credentialing application is required to become a member of each insurance network. Researching insurance plans in your area will help you decide which payers to prioritize and give you an idea of the process involved. Each insurer will have unique rules, reimbursement rates, and claims submission requirements. Billing to insurance companies will require an investment in software to help your office run smoothly and keep revenue flowing.

Selecting an EMR System
An electronic medical records (EMR) system is essential for maintaining patient records, scheduling appointments, and managing billing. Choose an EMR tailored to physical therapy practices, ensuring it includes features like treatment documentation, progress tracking, and data submission that is HIPAA compliant. At ZMark Health, we can help you decide on a system that will consider user-friendliness, customer support, and ease of billing so you can focus on patient care.

Staffing: Building Your Team
Hiring a support team is critical to your practice’s success. Start with essential roles like physical therapists, assistants, and administrative staff. Choose candidates with a commitment to patient care and the skills necessary to keep your practice running efficiently. Clearly define the roles and expectations and consider offering competitive salaries and flexible schedules to attract top talent.

Payment & Check-In
Congratulations! Your facility is open and ready for patients. To make a great first impression when they arrive, consider implementing a seamless check-in and payment collection system. For example, a touch-screen kiosk can guide a patient through payment collection, appointment scheduling and intake questions. Using a tablet for self check-in or having a knowledgeable staff member on hand can ensure appointments stay timely and necessary information is captured for billing and documentation purposes. Patients will appreciate stress-free appointments, and your practice will thrive under the adoption of clear, consistent payment policies.

Final Thoughts

Starting a physical therapy practice requires careful planning and execution. Selecting a strategic location, navigating billing options wisely, and investing in the right tools and team are the necessary foundations for a thriving business.

Now that you’ve had a chance to review the checklist, it’s time to schedule a meeting with our team at ZMark Health. Together, we’ll develop a plan, timeline, and action items to move you closer to launching your physical therapy business.

As we approach the start of a new year, one of our leadership team’s favorite exercises is to reflect on the prior year—celebrating successes and learning from failures. This process helps us map out our goals for the year ahead and identify opportunities for continuous improvement across our business.

As the leader of a large organization, I must remain diligent in balancing all facets of the business. This includes enhancing service delivery to clients, ensuring competitive compensation and benefits for our employees, and discovering new revenue streams to fuel growth.

In the healthcare industry, a similar exercise can be incredibly valuable for those leading large businesses. As 2024 comes to a close, it’s the perfect time to take stock of your successes and challenges and take action to improve areas you’d like to see progress in. The evolving healthcare landscape, with its new technologies, regulatory demands, and shifting challenges, calls for a proactive approach.

One common theme we heard throughout 2024 was the desire for healthcare organizations to improve their revenue cycle management. Specifically, many companies aimed to:

1. Improve collections
2. Do more with less, by staffing their billing departments efficiently and incorporating technology
3. Bring in a fresh perspective to assess their billing and collections processes and identify areas for improvement

Our firm specializes in conducting these types of reviews, and we are highly experienced in analyzing business operations to recommend actionable, effective strategies for improvement.

The beginning of a new year is a powerful opportunity to set strong goals and empower your team to achieve them.

If you’re looking to improve your revenue cycle in 2025, I encourage you to reach out for a conversation. We’d be happy to assess your billing and collections operations and provide you with a roadmap to success.

Here’s to a transformative year ahead!

Hospice care, a necessary type of medical care for those with terminal illnesses, has come under intense scrutiny in recent years due to fraudulent billing claims by a small number of dishonest providers. As agencies and committees take up the task of auditing and analyzing the billing practices of the industry, many providers are asking themselves how to restructure their revenue cycIe management to maintain their compliance. To prioritize patient care, it is essential for providers to troubleshoot their claims submissions, understand their billing data, and adopt proactive approaches to knowing every part of their RCM process.

In this blog, we’ll examine why hospice billing is under increased scrutiny, how to strengthen your RCM processes to avoid future issues and reinforcing the benefits of consistent billing and data analytics.

Hospice Billing Under the Microscope

Unfortunately, the acts of a few have caused trouble for many and hospice care providers are under more scrutiny than ever before as Medicare auditors and regulators analyze billing practices for potential fraud and overspending. With criminal charges filed against hospice providers and fraudulent billing cases making national news, it is vital for providers to understand their billing processes inside and out. Even unintentional billing errors could raise a red flag for auditors, causing unnecessary audits, disruption to patient care, or loss of Medicare certification.

With an increase in audits and regulations, it is essential for hospice agencies to review their revenue cycle management processes as a critical part of the business. A well-structured and thorough approach to your RCM can help reinforce your financial stability and legal standing as a hospice agency.

Auditing Red Flags

Auditors closely examine claims to get a better understanding of how hospice agencies bill for and use resources. Inconsistencies on these claims will immediately raise concern as to whether a hospice provider’s incorrect billing resulted in overpayment for services. As oversight intensifies, auditors and regulators are closely examining how hospice agencies allocate and bill for resources. This is especially true for Medicare, the largest payer for hospice care in the U.S., where improper billing or spending can trigger an audit.

Any of the following can raise a red flag for auditors:

• Upcoding services
• Missing documentation for billed services
• Lack of medical necessity
• Billing for services ordered by a provider, but not received by the patient

To reduce the risk of an audit, hospice providers must solidify their RCM practices and billing system. Through accurate documentation and records, remaining compliant with patient care, and the submission of timely and accurate claims, providers can vastly reduce the likelihood of

violations. To mitigate these risks, hospice agencies must implement a solid RCM and billing system that ensures accurate documentation, compliance with Medicare’s hospice coverage requirements, and timely claim submissions. With the right system in place, providers can reduce the likelihood of billing errors, missed claims, and compliance violations.

Prioritizing revenue cycle management allows hospice agencies to know their business inside and out and are well-positioned to survive an audit and avoid penalties.

Remaining Compliant with Data Analytics

At ZMark Health, we firmly believe in using data to optimize business operations and work with clients to help leverage their data to increase revenue and improve patient care. With hospice care, proactive data analysis is an effective way to maintain consistent claim filing and avoid red flag discrepancies. Monitoring your billing practices and financial data on a consistent basis can help you identify irregularities or potential issues before they escalate into compliance violations.

Proactive data tracking can:

• Track billing anomalies such as non-covered services or duplicate claim submissions (e.g., billing for services not covered or submitting duplicate claims)
• Monitor claim performance such as average days in accounts receivable or claim rejection rates
• Use patient medical records to ensure they meet the criteria for hospice care during recertification periods
• Help identify billing patterns that may lead to audits, such as a high volume of certain services performed

By using data to monitor operations, hospice agencies can maintain consistent billing practices and prevent errors that may trigger audits. Performing regular, internal audits of gathered data can help provide an extra layer of security and reveal any trouble areas that may need immediate attention.

How ZMark Health Can Help

Our team of experts have over 25 years of experience working in the hospice industry and we’re here to offer guidance and hands on support to help transform your billing practices, so you remain compliant and financially viable. We offer support in the following:

• Assistance with sequential billing issues
• Experience in collecting on VBID plans
• NOE submissions, claims billing, and collections
• Full-spectrum RCM services

Conclusion

As hospice care continues to face increasing scrutiny from auditors and regulators, the importance of a well-honed revenue cycle management system holds incredible value. Ensuring accurate, compliant billing practices not only protects your company from potential penalties but also creates a strong relationship between you and key payers such as Medicare.

Connect with ZMark Health today and learn how we can help you work through current billing issues, advise you on data analytics, and reinforce your RCM process so you can focus on providing the best hospice care possible.

Efficient and accurate medical billing is crucial for any practice’s financial health and disruptions to the revenue cycle can feel overwhelming. Managing these processes from the front end to the back end can be complex and time-consuming. As patient care continues from day to day, issues within the revenue cycle stack up over time and finding weak points in the process can feel impossible. Even with devoted staff, attentive management, and satisfied patients, issues can arise, often leading to lost revenue, compliance issues, and operational disruptions. While many healthcare providers turn to outsourcing, there’s an exciting alternative: utilizing advisory services for transparent and customized support.

Advisory services give a company the ability to optimize their revenue cycle management (RCM) while maintaining control of the billing process. Advisory services provide expert guidance on improving billing accuracy, reducing claim denials, and tracking missed payments with insurances, all while allowing you to keep the billing operations in-house. This approach helps maximize revenue and provides the internal team with additional knowledge and tools needed to implement better practices, leading to long-term stability and efficiency.

At ZMark Health, we have an experienced team of advisors ready to analyze the current operations of your practice and provide guidance on how to improve the inefficiencies of your current RCM. If you’re wondering how to turn things around without turning over full control, keep reading to learn about the benefits of advising and if this approach is the right step for your practice!

Control and Transparency

One of the main advantages of keeping your billing team in-house through the support of a knowledgeable advisor is the level of control and transparency it allows. Outsourcing means turning over financial data and access to patient accounts to a third party, which may not feel comfortable for some practices. Maintaining all current operations means direct oversight of how data is handled according to the standards set by your company.

Advisory services offer guidance and insight to help providers improve their internal processes without creating additional problems or stressors.

Cost Effective

Outsourcing RCM services can be expensive and structured to benefit larger providers through flat fees or a percentage of collections. Smaller or medium-sized providers with an interest in keeping costs low, would benefit more from short-term advisory compared to a longer commitment of outsourcing services. Costs add up quickly and targeted assistance through a consulting agreement could be the exact level of service your practice needs.

By paying for expertise only when necessary, practices can significantly reduce costs compared to full outsourcing. This cost-effective approach allows for better financial management while absorbing the benefits of professional guidance.

Customized Improvements

Every company is unique, with a set of specific needs, challenges, and approaches to patient care. Outsourced services typically use a standardized approach to revenue management and may not take into consideration all the intricacies that make your practice special. On the other hand, an advisor works closely with your team to understand how your company runs and provides tailor-made solutions to improve operations.

A personalized approach addresses more than simply improving the bottom line. Through data analytics, clinical process audits and a review of overall patient satisfaction, a customized plan is used to implement necessary changes throughout the entire revenue process.

Educate, Empower, Implement

One of the key roles of a medical billing advisory service is to educate your internal team. Rather than simply taking over the billing process, advisors work to improve the existing skills of your staff, ensuring they have the knowledge and tools needed to manage denials, patient collections, and all aspects of the RCM more effectively. These tools lead to long-term benefits through empowerment and greater understanding of processes. Your team will become more proficient and confident in handling tasks and, ultimately, reduce errors and increase efficiency.

Adding an educational component to the advisory process allows staff to learn new standards together, gain insight into the importance of streamlining the revenue cycle, and fosters adaptability in the ever-changing healthcare industry.

Scalability and Flexibility

As a company grows, the billing needs will likely evolve as well. Outsourcing may help resolve leaks in the revenue stream, but a longer-term contract may not help with increased patient volume or changes to service offerings. With an advisory service, you can utilize the support during a period of growth, stagnation, or recovery, and maintain flexibility with your operations. An experienced advisor can help a company develop tailored strategies to navigate these changes without disrupting the flow of revenue.

Consider how an outside party will support today’s problems while remaining flexible for future growth.

Conclusion

A robust and well-functioning revenue cycle is crucial for the financial health of any healthcare practice. Outsourcing might seem like the ideal solution and yield results over time but comes with trade-offs such as higher costs or loss of control. By utilizing a provider advisory service, practices can optimize their processes and empower their teams, all while keeping operations in-house.

In our blog post on analytics, we discussed how ZMark Health advisors use data to support providers and organizations. Through data analysis, our advisors gain an understanding of billing workflows and clinical processes to provide transparent and customized solutions that best fit your practice. Data assessment allows for an advisor to zone in on specific challenges and areas of improvement and allows a company to maintain these changes on their own. If you want a more efficient and effective practice, consider reaching out to ZMark Health to learn how an advisor could best support your company in reaching these goals.

Today’s healthcare landscape is constantly changing and one of the best ways to pave a successful path forward is with data analytics. Through data tracking and analysis, providers can optimize patient care and increase revenue by using current, available resources. By leveraging their data through advanced analytics, medical providers can make more informed decisions, optimize their business operations, and boost financial performance.

As discussed in a previous blog post, Revenue Cycle Management (RCM) drives a business. Once a patient is scheduled, there are many steps involved to ensure a final payment is received for services provided. Extracting and analyzing revenue cycle data from such areas as patient registration or claim denials, can improve processes within the RCM by addressing such things as staff efficiency or coding errors.

Solving Problems Through Data

Analytics in healthcare is the systematic use of data and statistics to gain further insight into business operations. To implement effective changes to any practice, it is important to understand the root cause of operational or financial problems. By analyzing data, medical providers can identify trends, uncover hidden patterns, and make data-driven decisions that can significantly impact their bottom line.

Inefficient RCM can lead to a significant loss in revenue and temporary fixes or budget adjustments will not always solve problems in the long term. To identify where to fix the problems, it is necessary to do a deep dive into the operations data. For example, reviewing all claim denials from the past year can pinpoint areas of improvement to help streamline income. Denials due to mistakes in patient registration or underpayments by an insurance company can be signs of consistent, unresolved errors or issues. Once you understand the data, you can pinpoint the areas of improvement in the revenue cycle and implement changes quickly and successfully.

Enhancing Revenue Cycle Management

Data analytics can reform the financial health of a company by collecting, understanding, and interpreting the unique data points that make up the business. Data provides insight into where and how current RCM strategies are working or falling short. Effective revenue cycle management is essential for maintaining a healthy cash flow, maximizing revenue, and creating transparent billing practices for patients. Analytics can provide valuable insights into various aspects of RCM, help providers identify areas for improvement and implement strategies to enhance financial performance.

Data analytics can revolutionize current RCM practices and change how providers manage their business. Successful implementation of actionable insights can create workflow efficiency, reduce revenue leaks, and streamline billing processes.

How ZMark Can Help

At ZMark Health, we work with providers and organizations to track revenue and improve clinical processes using data analytics. For example, by understanding the workflow between a provider and insurance companies, we help create methods to monitor gaps in data and implement changes to reduce denials and follow-ups.

Additionally, ZMark helps clients understand the relationship between clinical processes, EHR usage and data, which allows an organization to make operational changes that support more accurate and transparent reporting capabilities. When asked about data analytics, ZMark Health Director of Advisory Services Jennifer Short offered this insight: “ZMark has worked with organizations of all sizes, and in multiple healthcare industries, to increase efficiencies in operational processes which leads to enhanced visibility into data analytics and more accurate and transparent reporting. Our goal is to help our clients learn, grow and become able to maintain these new processes on their own.”

If you’re interested in learning more about how data analytics and simple changes in your RCM can transform your organization, reach out to ZMark Health today to get started!