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, Data Translation, Data Validation, EHNAC Accreditation, 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 convoluted […]
Ambient Data Capture, Billing AI, Billing Software, Billing Workflow, Robotic Process Automation, 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 for […]
Advanced Beneficiary Notice, Medicare Coverage for Toxicology Tests, Medicare Reimbursement, Toxicology Billing
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 as […]
CMS, Geographical Practice Cost Index, Inpatient Prospective Payment System, IPPS, Medicare Billing, Prospective Payment Systems
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 rechecking codes, filling out endless forms. It’s enough to […]
Billing Automation, Denial Write-Offs, RPA
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 […]
CPT Codes, Remote Patient Monitoring Billing, RPM Billing, RPM CPT Codes
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 […]
Billing Startup, RCM Startup, Revenue Cycle Management, Start a Medical Billing Company
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 Systemic Reform, Billing Transparency, No Surprises Act, Revenue Cycle Management
You run a medical practice or a healthcare facility, and the clinical side of the job is demanding enough without billing chaos on top of it. But if nobody has ever sat down and mapped out your practice’s actual billing workflow, step by step, that gap is costing you money right now. Billing is what […]
Billing Best Practice, Denial Management, Financial Visibility, Medical Billing, Revenue Cycle Management
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 […]
Better Patient Experience, Billing Automation, Digitization of Medical Billing, Revenue Cycle Management, RPA
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 […]
Cytopathology CPT Codes, Immunohistochemistry, Pathology Billing, Pathology CPT Codes, Surgical Pathology CPT CodesEfficient 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 […]
Billing Software, Billing Workflow, Interoperability Standards, NLP, RCM
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. […]
DNA Testing, Genetic Testing Billing, Genetic Testing Reimbursement, Genetics, Revenue Cycle
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 […]
Interoperability, No Surprises Act, Regulatory Changes, Telehealth, Value Based Care
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 […]
Audit Preparedness, Claim Coding, Denial Management, Patient Financial Experience, Revenue Forecasting
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 Management, Benefits Verification, Coding Accuracy, Denial Management, Patient Eligibility, Payer Contracting
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 […]
Biomarker Billing, Breast Cancer Billing, Chemotherapy Billing, Diagnostic CPT Codes, Mammography Billing, Surgical CPT Codes
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, […]
DBS for Addiction Treatment, Deep Brain Stimulation, Neurotechnology, Pathological Neurobiology, Substance Abuse
Artificial intelligence is now used across every major stage of the revenue cycle, from insurance eligibility verification before the patient arrives to denial prediction and payment posting after the claim is adjudicated. The core applications are claim scrubbing, automated coding suggestions, prior authorization status monitoring, denial pattern analysis, and patient payment engagement. Each one addresses […]
AI RCM, Artificial Intelligence, Charge Capture, Data Analysis, Denial Management
The healthcare industry continues to embrace technological innovations. The integration of artificial intelligence (AI) solutions like ChatGPT in Revenue Cycle Management (RCM) holds immense promise for optimizing financial processes and improving operational efficiency. We cover potential applications and challenges associated with leveraging ChatGPT in RCM. Understanding Revenue Cycle Management Before delving into the potential of […]
AI-driven RCM, ChatGPT Healthcare, ChatGPT in RCM, Healthcare AI, OpenAI
There are two main ways that insurance companies respond when they decide not to pay a claim, denial and rejection. Both indicate the claim will not be paid, but there are some important differences between the two. The distinction is critical for medical providers to correctly follow-up so they can get claims paid appropriately. Let’s […]
Claim Denial Rate, Claim Rejection Rate, Denial Management, Denial vs Rejection, Revenue Cycle Management
HL7 and FHIR are both standards developed by Health Level Seven International for exchanging healthcare data between software systems, but they represent different generations of the same effort. HL7 v2.x, the version most widely deployed today, was developed in the late 1980s to enable data exchange between hospital information systems using pipe-delimited message segments. FHIR, […]
Billing Automation, Interoperability, Message Exchange Patterns, RESTful API, RPAIn the intricate world of medical billing and coding, understanding Common Procedural Terminology (CPT) codes is paramount. These codes act as a universal language, facilitating seamless communication between healthcare providers and insurance entities. Let’s delve into the realm of CPT codes, exploring their significance and shedding light on the most commonly used ones. Decoding CPT Codes: […]
CPT Codes, Medical Billing, Medical Reimbursement, Revenue Cycle Management
Diagnostic testing for COVID-19 has become a cornerstone of pandemic response for healthcare providers. However, rolling out testing services presents immense challenges around reimbursement and revenue cycle management. This definitive use case walks through COVID-19 testing billing and coding procedures in 2022 step-by-step, using examples to illustrate how to optimize claims submission and payment across […]
COVID-19 Test Billing, CPT Codes, Revenue Cycle Management
The healthcare industry is undergoing a digital transformation, with software-based therapeutic interventions known as digital therapeutics emerging as disruptive new modalities to prevent, manage, and treat a growing range of medical conditions. Digital Therapeutics Breakdown Digital therapeutics deliver evidence-based treatments directly to patients through smart devices and applications. These data-driven tools provide personalized interventions, feedback, […]
Digital Therapeutics Billing, DTx Billing, Reimbursement, Revenue Cycle Management