Home infusion therapy is a treatment option that allows patients to receive intravenous (IV) medications, fluids, or nutrition at home. This approach has become increasingly popular as it offers convenience, promotes patient independence, and reduces healthcare costs associated with prolonged hospital stays. However, to ensure proper reimbursement and accurate billing, healthcare providers must understand and […]
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Clearinghouses play a crucial role in facilitating the electronic exchange of data between providers, payers, and other entities. Clearinghouses act as intermediaries, converting data from proprietary formats used by different systems into standardized formats that can be understood by all parties involved. With so many clearinghouse options available, selecting the right one can be a […]
CAQH CORE Certification, clearinghouse, EHNAC Accreditation, EHR, EHR Integration, EMR, EMR integration, HIPAA Compliance, HL7, HL7 interoperability, HL7 Standards, Regulatory Compliance, Value-Added Services
If you’re a healthcare provider, dealing with medical billing is probably one of your least favorite parts of the job. It’s a total pain – keeping track of patient information, filing claims, following up on denials, and ensuring you actually get paid for your services. And let’s be honest, the medical billing process is incredibly […]
A/R, Billing Tech, Billing Technologies, Business Intelligence, Claim Scrubbing, Data Analytics, Denials, EHR, EMR, KPIs, Patient Portals, RPA, Rules-Based Claim Scrubbing
Let’s talk about getting reimbursed by Medicare for toxicology tests – those tests that check for drugs or other harmful substances in someone’s body. It can be a confusing process with lots of rules and hoops to jump through. I’m going to break it down simply so you know what to expect. Understanding Medicare Coverage […]
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If you’re a healthcare provider or facility dealing with Medicare, one thing is certain – getting properly reimbursed is a maze filled with complex rules, convoluted paperwork, and often, sheer frustration. Medicare reimbursement is the lifeblood that keeps many healthcare operations afloat, but navigating its serpentine pathways can feel like a daily battle. Buckle up […]
APC, APCs, CMS, Geographical Practice Cost Index, healthcare, Healthcare Billing, Inpatient Prospective Payment System, IPPS, Medical, Medical Billing, medicare, medicare billing, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare Physician Fee Schedule, Medicare Reimbursement, Medicare Severity Diagnosis Related Groups, MIPS, MS-DRG, OPPS, Prospective Payment Systems, Revenue Cycle, Revenue Cycle Management
Let’s be real – medical billing can be a huge pain. For those who perform it internally and externally. At times, it’s one of those mind-numbingly tedious tasks that makes you question your career choices. Hours upon hours of copying and pasting data from one system to another, checking and re-checking codes, filling out endless […]
Automation, Billing Automation, EHR, EMR, EMR Data Extraction, EMR RPA, Medical Billing Automation, Robotic Process Automation, Robotic Process Automation Billing, Robotic Process Automation Medical Billing, RPA, RPA Adoption
If you’re a healthcare provider looking to get into remote patient monitoring (RPM), one of the first things you need to understand is how to bill for these services. And that starts with knowing the right CPT codes to use. RPM has been around for a while, but it really took off during the COVID-19 […]
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So you want to start your own medical billing company? It’s a lucrative industry with a ton of potential, but also one that requires some specialized knowledge and an understanding of the healthcare system. Don’t worry though, I’m going to walk you through all the key steps for getting a medical billing business off the […]
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Let’s face it – claim denials are the bane of every medical practice’s existence. They’re like kryptonite sapping the strength from your revenue cycle. But what if we told you there was a way to turn those denied claims into a money-making superpower? No, we’re not peddling some snake oil solution. I’m talking about adopting […]
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If you’ve ever received a medical bill, chances are you were confused, frustrated, or both. The bills are often filled with inscrutable codes, massive dollar amounts that seem to make no sense, and a complete lack of clarity around what you’re actually being charged. It’s a systemic problem in the US healthcare industry that leads […]
American Hospital Association, billing, Billing Systemic Reform, Billing Transparency, CMS, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Transparency, No Surprises Act, Revenue Cycle, Revenue Cycle ManagementSo you run a medical practice or healthcare facility. Congrats, you’re doing important work that helps keep people healthy. But have you put much thought into your medical billing workflows? If not, you really should. Billing is the lifeblood that keeps a healthcare operation afloat financially. It’s how you get paid for the vital services […]
AI, Automation, billing, Billing Workflows, Financial Visibility, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Workflows, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, RPA
The healthcare industry has long been grappling with the complexities of revenue cycle management (RCM), a critical process that encompasses all administrative and clinical functions associated with capturing patient service revenue. Traditionally, revenue cycle management has been a labor-intensive and error-prone process, often plagued by inefficiencies, delays, and compliance issues. However, the advent of revenue […]
Appeal Management, Automated Eligibility Verification, Claims Scrubbing, denial management, Eligibility Verification, Intelligent Data Capture, OCR, Optical Character Recognition, Payment Posting, Predictive Analytics, Revenue Cycle Automation, Revenue Cycle Automation Tools, Revenue Cycle Management, Robotic Process Automation, RPA
In the healthcare ecosystem, one aspect that has undergone a remarkable transformation is the way medical bills are processed and submitted. Gone are the days when mountains of paper claims and endless filing cabinets were the norm. Instead, healthcare providers have embraced the power of electronic medical billing systems, revolutionizing the revenue cycle management process and […]
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Pathology is a branch of medicine that deals with the study of diseases, particularly through the examination of bodily fluids, tissues, and organs. Pathology services play a crucial role in the diagnosis and management of various medical conditions, and proper coding and billing procedures are essential for reimbursement from insurance companies and other payers. The […]
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Denial management has emerged as a critical component for healthcare providers and organizations. As payers become more stringent in their reimbursement policies and regulatory requirements tighten, effective denial management strategies are essential for minimizing revenue leakage and ensuring financial stability. According to industry reports, up to 90% of denied claims are recoverable, representing a significant […]
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Efficient medical billing processes are crucial for maintaining a healthy revenue cycle and to ensure the financial well-being of healthcare providers. With the increasing complexity of payer regulations, coding intricacies, and patient expectations, medical billing workflows can quickly become convoluted and inefficient, leading to costly delays, errors, and dissatisfied patients. Fortunately, through the implementation of […]
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The field of genetics has experienced remarkable advancements in recent years, revolutionizing our understanding of human health and disease. Genetic testing, in particular, has become an invaluable tool in the diagnosis, treatment, and prevention of various conditions. However, the rapid pace of innovation has also brought forth a complex landscape of coverage and reimbursement challenges. […]
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The healthcare industry is dynamic, and staying up-to-date with the latest regulatory changes is crucial for efficient Revenue Cycle Management (RCM). RCM encompasses the processes involved in tracking and collecting patient service revenue, from the initial registration and appointment scheduling to the final payment of balances. Failure to comply with regulatory requirements can result in […]
Affordable Care Act, Coding and Documentation, Cybersecurity, Data Privacy, Environmental Sustainability, Health Equity, HIPAA, Interoperability, No Surprises Act, Non-Discrimination Regulations, Patient Access, Price Transparency, Regulatory Changes, Regulatory Compliance, Regulatory Requirements, telehealth, Value Based Care, Virtual Care Regulations
Healthcare organizations are swimming in an ocean of information. From electronic health records to claims data, patient surveys to online reviews, the sheer volume of data can be overwhelming. However, this data holds the key to unlocking insights that can vastly improve revenue cycle management (RCM) processes and drive better financial outcomes. When harnessing the […]
artificial intelligence, Big Data, Cloud Computing, Data Analytics, Data Democratization, Internet of Things, IoT, Machine Learning, Predictive Analytics, Prescriptive Analytics, RCM Data Analytics, Self-Service Analytics
The healthcare revenue cycle management (RCM) process is a complex and critical set of activities that encompasses everything from patient registration and appointment scheduling to final payment collection. With rising costs, shrinking reimbursements, and increasing regulatory burdens, optimizing RCM performance has become essential for provider organizations to ensure financial viability and sustainability. We cover four […]
billing, Case Studies, Charge Capture, Denial Analytics, denial management, Denial Trends, healthcare, Medical, Medical Billing, rcm, RCM Case Studies, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Cycle Process, Revenue Integrity
The medical billing process is a complex and often daunting task for healthcare providers. From keeping up with ever-changing regulations and coding updates to managing denials and claim rejections, medical billers face numerous challenges that can significantly impact revenue cycle management and the financial health of a practice. We cover 10 key medical billing challenges […]
A/R, A/R Management, Benefits Verification, COB, Coding Accuracy, denial management, HIPAA, HIPAA Compliance, Patient Eligibility, Payer Contracting, Revenue Cycle Management, Revenue Cycle Process, revenue optimization, Timely Claim Submission
The healthcare industry is undergoing massive changes. With rising costs, declining reimbursements, and shift towards value-based care, healthcare providers face significant financial pressures. At the same time, patients demand superior access, quality, and lower out-of-pocket costs. To thrive in this environment, healthcare organizations must adopt a strategic approach to revenue optimization. Revenue optimization involves systematically […]
Better Payer Contracts, billing, Clinical Documentation, healthcare, Healthcare Billing, Medical, Medical Billing, patient payments, rcm, Renegotiate Payer Contracts, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Integrity, revenue optimization, Value Based Care, Value Based System
Breast cancer is one of the most common cancers among women in the United States, with about 1 in 8 women developing invasive breast cancer over their lifetime. As breast cancer incidence has increased over the past several decades, advances in screening, diagnosis, and treatment have also greatly improved. Breast cancer death rates have fallen […]
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Opioid addiction is a chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences. It is considered a major public health crisis in many parts of the world including the United States, where over 47,000 opioid overdose deaths occurred in 2017 alone. While medications and behavioral therapies can be helpful for some, […]
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Revenue cycle management (RCM) is a crucial part of running any healthcare organization. It involves everything from patient registration and eligibility verification to medical coding, charge capture, claims submissions, payment posting, denial management, and more. The goal is to maximize reimbursements while reducing costs and inefficiencies. In recent years, artificial intelligence (AI) has emerged as […]
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