Medicare and Medicaid Fraud Vulnerability The Medicare and Medicaid programs provide crucial support to millions of Americans, offering access to healthcare services for those who may not otherwise be able to afford it. Unfortunately, these programs are also vulnerable to fraud, with criminals exploiting the system to enrich themselves at the expense of taxpayers and […]
Billing for Services Not Rendered, Billing Fraud, False certification, Fraud, Kickbacks, Medicaid, Medicaid Fraud, Medical Billing Fraud, Medicare, Medicare Fraud, Phantom billing, Prescription Drug Fraud, Supply fraud, Unlawful self-referral, Upcoding, Whistleblower, Whistleblower Protection Act
The Value of Using an Outsourced Medical Billing Company The Complex Nature of Medical Billing Healthcare providers are faced with a growing number of challenges when it comes to managing their medical billing operations. With the complex nature of healthcare billing, the increasing regulations and laws that govern the industry, and the need to stay […]
Healthcare, Healthcare Billing, Medical Billing, Medical Billing Company, Outsource Medical billing, Outsourced Billing, Revenue Cycle Management
What are ICD-10 Codes? ICD-10 codes are the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification system used worldwide to classify and code diseases and health conditions. The ICD-10 codes are used by healthcare providers and insurance companies to accurately describe and categorize medical diagnoses, treatments, […]
Healthcare, Healthcare Billing, ICD-10, ICD-10 lookup, ICD-11, Medical Billing, Reimbursement, WHO, World Health Organization
What is Genetic Testing? Genetic testing is a medical process that involves analyzing a person’s DNA, the building blocks of their genes, to look for specific changes that can indicate the presence of a genetic disorder or an increased risk of developing a certain condition. Genetic testing can be used to diagnose a variety of […]
What is Medical Credentialing? Medical credentialing is a vital process for ensuring the quality of healthcare services. It involves verifying the education, training, and professional experience of healthcare providers to ensure that they meet the standards for practicing in their field. This process helps to ensure that patients receive safe, effective, and appropriate care from […]
Credentialing, Healthcare, Healthcare Credentialing, Medical, Medical Credentialing, What is Medical Credentialing
Substance abuse refers to the harmful use of drugs or alcohol with negative consequences on an individual’s health, relationships, and daily life. The term encompasses a range of substance use disorders, including addiction and abuse, and is a growing concern in the United States and around the world. Substance abuse is a complex issue that […]
Opioid, Opioid Addiction, Opioid Addiction Billing, Overdoses, SAMHSA, SBIRT, SBIRT reimbursement, Substance Abuse and Mental Health Services Administration
COVID-19 has brought the world to a standstill, and the demand for effective testing has skyrocketed. In this blog post, we will discuss COVID-19 test kit reimbursement and the different types of kits available. It depends on the country and healthcare system, but generally COVID-19 test kits are reimbursed if they are performed in a […]
COVID-19, COVID-19 billing, COVID-19 test kit, COVID-19 test kit billing, COVID-19 test kit reimbursement, COVID-19 test kits, COVID-19 testing
Medical Billing: Basics, Role of Specialists, Challenges, RPA and What to Look for in a Company Medical billing is an important aspect of the healthcare industry that plays a crucial role in ensuring that patients receive the medical treatment they need while healthcare providers are reimbursed for the services they offer. The process involves submitting […]
Billing Accuracy, HIPAA, HIPAA Compliant, Medical Billing, Medical Billing Compliance, Medical Billing Customer Service, Medical Billing Expertise, Medical Billing Robotic Process Automation, Reimbursement Rates, Robotic Process Automation, RPA
Uncompensated Healthcare in the Form of Charity Care and Bad Debt are Painful for Providers Uncompensated care is a widespread pain point for healthcare organizations, rising by just over a billion dollars in 2020 to $42.7 billion. And while it may not be thinkable to get rid of it, there are tactics you can introduce […]
Charity Care, Charitycare, Healthcare, Healthcare Debt, Medical, Medical Care, Medical Charity, RCM, Revenue Cycle Management (RCM), Uncompensated Healthcare
In the wake of months of social distancing and virtual visits during the COVID-19 pandemic, patients are once again veering towards a need to see their physicians in person. As patient volume recovers, it’s a great time to take a look at a healthcare practice’s Revenue Cycle Management (RCM) program and make sure it’s still up […]
AI, Artificial Intelligence, Artificial Intelligence Healthcare, COVID, COVID-19, Data Security, Machine Learning, Medical Billing, RCM, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
Even healthcare providers who deploy safeguards to dodge insurance payment hazards, occasionally find themselves up against a claim denial. Taking care of denied insurance claims can be a frustrating process for healthcare practitioners and their office staff. That’s why it’s vital to utilize a claim denial management strategy to recognize, solve, recover and avoid denied […]
Billing, Claim Denial, Claim Denials, Claim Rejections, Denial Management, Denied Medical Claim Prevention, Denied Medical Claims, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Claim Rejections, Medical Claims, Medical Payor, RCM, Revenue Cycle Management
Is Revenue Integrity Critical in Healthcare? What is Revenue and Why is it Important? The exact wording may vary, but you can look for terms such as “gross revenue,” “gross sales,” or “total sales.” This figure is the amount of money a business brought in during the time period covered by the income statement. The […]
Healthcare, Healthcare Revenue, Healthcare Revenue Integrity, Medical Revenue Integrity, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Integrity
As a healthcare provider, your goal is to help people. However, this type of work is unsure at times. If a healthcare worker makes a misstep, they could harm a person’s health. Even if there hasn’t been any maltreatment or mistake on the part of the healthcare practitioner, disagreements can result when physicians’ and patients’ […]
General Liability, General Liability Insurance, Health Insurance, Healthcare, Healthcare Practice, Insurance, Medical, Medical Billing, Medical Credentialing, Medical Practice
What’s the Difference Between a Skilled Nursing Facility and a Nursing Home? On the surface, a skilled nursing facility and a nursing home may appear rather the same. In fact, some care facilities actually function as both, with a distinct floor or section of a building dedicated to each. The difference between a skilled nursing […]
Billing, Medical Billing, Medical Billing Service, Nursing Billing, Nursing Facility Billing, Nursing Home, Old Folks Home, Skilled Nursing, Skilled Nursing Billing, Skilled Nursing Facility, Skilled Nursing Facility Billing
Why Your Patients are Failing to Use Your Portal Properly Patient Portal Challenges Healthcare consumers vary from tech-savvy Generation Z, Y and Millennials, familiar with rapid click-throughs, to straightforward answers, to patients with little or no faith or proficiency in computing tools. In any instance, just a few words can sum up the probable value-added […]
Confusion, Medical Patients, Medical Practice, Patient Portal, Patient Portal Problems, SecuritySubmitting Electronic Claim Attachments One of the major strains on healthcare providers is the dependence on paper and manual procedures. This duo frequently adds up to harmful mistakes and costly denials, which demand significantly more time and effort to resolve, if left unchecked. Among the manual processes most difficult to manage are claim attachments that […]
Clearinghouse, EHR, Electronic Claim Attachments, Electronic Claims, EMR, Medical Billing, Medical Billing Software, Medical Billing Team, Medical Billing Tool, Outsourced Billing, Outsourced Medical Billing, RCM, Revenue Cycle Management
Social Media and Patient Privacy in Healthcare A Few Use Cases Use Case #1: Use Case #2: Protected Health Information (PHI) Preserving privacy of patients’ protected health information (PHI) is one of the major concerns linked to social media in healthcare. Privacy and protection of such information are dealt with in federal law and overseen […]
Facebook Healthcare, HIPAA, HIPAA Compliant, Instagram Healthcare, Internet HIPAA, Medical Billing, Medical Credentialing, Patient Privacy, PHI, Privacy, Safety Violations, Social Media, Social Media Healthcare, Social Media HIPAA, Social Media Medical
HL7 (Health Level Seven) is a standard for swapping health information between medical applications. This standard identifies a format for the transmission of health-related information. Information transmitted using the HL7 standard is sent as a collection of one or more messages. Each message sends one record or item of health-related information. Background on HL7 Format Two […]
Healthcare Delivery, Healthcare Format, Healthcare HL7, HL7, HL7 Standards
Let’s begin with this set-up: Let’s say you’re hunting for a new job and receive a call from a would-be employer informing you that the job is yours. Of course, you’re thrilled by the news and inquire about your starting salary. Your new employer replies that you need to wait for your first paycheck to […]
Credentialing, Healthcare Credentialing, Medicaid, Medicare, Private Insurers, Provider Credentialing, Provider Networks, Reimbursement RatesHiring new providers brings energy and growth to any medical practice. Whether you’re bringing on a physician, nurse practitioner, or physician assistant, adding talented healthcare professionals to your team opens doors to serving more patients and expanding your services. But there’s a catch that trips up even experienced practice managers, getting these new providers ready […]
Credentialing, credentialing on-boarding, Enrollment, Healthcare, Healthcare Credentialing, Medical Credentialing, Payer Enrollment
EHR Systems + Medical Billing Integration Medical billing and practice management has long been a labor-intensive task for healthcare providers. There’s little doubt, however, that the use of EHR (Electronic Health Records) or sometimes known as EMR (Electronic Medical Records) has considerably slashed these tasks by offering providers a proven method to effectively streamline their […]
Billing, Billing AI, Billing Automation, Billing Revenue, Billing Service, EHR, EHR (Electronic Health Records), EHR Integration, EHR Interoperability, Electronic Health Records, Electronic Medical Records, EMR, EMR (Electronic Medical Record), Health Level 7, HL7, Insurance, Interoperability, Interoperability Standards, Medical Billing
What Healthcare Providers Need to Know about Vaping Both the U.S Food & Drug Administration and the Centers for Disease Control are working determinedly to look into the disturbing occurrences of severe respiratory illness connected with the use of vaping products. Both organizations are diligently working with state and local health officials to investigate these […]
Cancer, CDC, e-cigarette, EHR, Healthcare, Lung Association, Vape, Vape Pen, Vaping, Vapor
Medical Practice Management Challenges Solved by Outsourced Medical Billing Quality, Outsourced Medical Billing is the Answer The billing team at Capitol Healthcare practice had been reaching a high bar of excellence. But that bar was endangered when long-time staff members began to retire. “Some of the staff had been here for a long time, like […]
Healthcare Billing, Insurance, Medical Billing, Medical Billing Service, Medical Billing Strategy, Medical Credentialing, Outsource Billing, Outsource Medical billing, Outsourced Billing, Outsourced Medical Billing, Revenue Cycle Management, Revenue Cycle Optimization
Example of AI in Medical Billing and Coding Artificial Intelligence (AI) is a hot topic right now with many speculating on how it will change the way we live our lives. In fact, we’ve already discovered that in the medical field, there are numerous ways that AI can be employed to improve overall performance. As […]
AI, Artificial Intelligence, Artificial Intelligence Healthcare, Billing, Billing AI, EHR, EHR RPA, Health Level 7, Healthcare AI, HL7, Insurance, Medical Billing, Medical Billing AI, Medical Billing Artificial Intelligence, RPA
Telehealth is Useful, but is it Here to Stay? Maybe we really don’t want to talk about it, but truth is, major calamities like the COVID-19 pandemic often lead to innovations in healthcare. As a prime example, the use of virtual care skyrocketed as people, asked to socially distance, looked for substitutes for in-person visits. […]
AI, AI in Healthcare, AI in Telehealth, AI Telehealth, Corona, Corona Virus, Coronavirus, COVID, COVID-19, Healthcare, Healthcare Delivery, Healthcare Outcomes, Ian Tong, Meg Barron, Telehealth, Telehealth AI, Telemedicine