Five run on drug economics. Something is bought before it is given, the units depend on the patient, and what you may bill depends on who paid for it. Oncology is the most expensive version of that and pediatrics the highest-volume one, and they fail in the same places. Three are procedural, where the money leaks inside bundled periods and benefit ceilings instead. We would rather group them honestly than publish a longer list.
A practice buys a drug that costs more than the visit, gives it to a patient whose weight decides the units, and finds out afterwards whether the plan agreed to pay for the drug, the chair and the nurse or only some of those. That is oncology. It is also rheumatology, the MS side of neurology, and the infusion suite of a GI practice. Pediatrics is the same shape at the other end of the price list: the dose is a vaccine, the stock it came out of decides whether the product is yours to bill at all, and the administration is counted per component rather than per injection. The drug names change. The machinery does not.
Orthopedics, OB/GYN and dentistry are a different discipline and we would rather say so than file them under the same heading to make the list look tidy. Their money leaks inside bundled periods, in equipment and devices carried on the practice balance sheet, and in documentation that did not keep up with what actually happened in the room. Where they do touch buy-and-bill, in viscosupplementation and in contraceptive devices, they behave exactly like the drugs above.
Dentistry is the odd one, and it is worth being straight about why it is here. Nothing about it resembles a drug claim. It is on this list because it fails the way the rest of this site is built around: quietly, in a place nobody is looking. A dental plan has a ceiling and pays the cheaper version of the treatment when it can, so the loss arrives as an underpayment rather than a denial and never reaches a denial report. And the most valuable work a dental practice does, the surgical and medically necessary end of it, belongs on a medical claim. Those two habits are the same habit: read the remittance, and send the claim to the carrier that owes it.
Something was bought before it was given, and what you may bill depends on who bought it. Then the units, the components and the authorization decide whether the claim survives contact with the payer. Oncology is the most expensive version of that question. Pediatrics is the highest-volume one. One skill, five drug lists.
High-cost drugs, unforgiving unit math, and payers that deny first and ask questions later. The hardest version of this problem, which is why we built the company around it.
The same questions as oncology at a fraction of the value and many times the volume. Who owned the dose, how many components went in, and whether the child was eligible that morning.
The same machinery, with an extra problem on top: half the time the drug is not yours to bill at all, and which half changes by payer.
Oncology unit math stretched over a six-month clock, plus restricted distribution programs that never appear on the claim and can still invalidate one.
Two businesses in one practice. The infusion suite fails the way oncology does; the endoscopy suite fails on bundling edits and a screening that stopped being one.
No infusion suite here. The money leaks through bundled periods, documentation that did not keep up with the procedure, and queues nobody is ageing separately. Dentistry leaks somewhere else again: into a plan with a ceiling on it, and into work that should have gone to the medical carrier.
Revenue leaks inside global periods, in equipment dispensed without the enrolment to bill it, and in a work comp queue ageing on a different clock.
One bundled code covers nine months, and most of what goes wrong is a version of the same question: does the global package still apply to this patient.
A benefit plan built to run out, and a share of the work that belongs on a medical claim instead. Most of the loss here is a downgrade or a ceiling, not a denial.
