A medical claim is the formal request a healthcare provider submits to an insurance payer asking for reimbursement for services delivered to a covered patient. Every claim contains standardized codes identifying the diagnosis, the procedure performed, and the provider who delivered care, along with patient demographics, insurance information, and the amount billed. The payer reviews […]
Claim Denials, Claim Rejection, Denial Management, Medical Billing, Medical Claims
Pharmacogenetics refers to the study of how genetic variability impacts drug response. Also called pharmacogenomics, PGx testing analyzes a patient’s genetic makeup to predict drug efficacy, optimal dosing, and risk of adverse reactions. As our understanding of genetics has advanced, there has been growing recognition of its role in mediating drug metabolism and effects. Many […]
CPT Codes, PGx Billing, PGx CPT Coding, Pharmacogenetics Billing
The COVID-19 pandemic triggered an explosion in telehealth utilization across healthcare. While telehealth billing processes matured during the public health emergency, new complexities are emerging as virtual care delivery models expand. Practices must stay updated on billing and coding guidelines for telemedicine services spanning video visits, remote patient monitoring, mental health apps, and more. We […]
Medical Billing, RCM, Remote Patient Monitoring, Telehealth, Telemedicine
Medical billing is a core function that impacts practice revenues, costs, and efficiency. A key decision practices face is whether to handle billing internally or choose an outsourced billing service. What are the relative benefits and drawbacks of each model? We examine the pros and cons of in-house vs outsourced billing to help practices select […]
Billing Risks, In-House Billing, Outsourced Billing, Staffing Challenges
For modern healthcare practices, efficient and accurate medical billing operations are essential to financial success. However, manual billing processes can be time-consuming, error-prone, and make it difficult to scale. Automating key steps in the medical billing workflow brings game-changing improvements in productivity, reduction of costly claim errors, accelerated revenue cycles, and optimized billing costs. Benefits […]
Billing Automation, Higher Reimbursements, Revenue Cycle Management, Robotic Process Automation
Selecting the right medical billing software is crucial for modern healthcare practices looking to optimize their revenue cycle. However, with hundreds of solutions on the market, all touting advanced features, it can get overwhelming for practices to figure out the best fit. Must-Have Medical Billing Software Features While each practice has unique requirements, some core […]
Billing Software, HL7, Medical Billing, Robotic Process Automation
ICD-10 codes are a set of alphanumeric medical diagnosis and procedure codes used for medical billing and clinical documentation. Maintained by the World Health Organization, ICD-10 contains about 69,000 codes compared to 13,000 in the older ICD-9 version. The codes provide specificity around body location, severity, comorbidities, and episode of care. Implementation of ICD-10 in […]
Clinical Documentation, ICD-10 Optimization, ICD-10 Update, Medical Coder Training
Accuracy in both medical coding and billing processes is imperative for maximizing appropriate reimbursement, maintaining regulatory compliance, and optimizing revenue cycle performance. Even minor errors can have major consequences in delayed or reduced payments, denied claims, and compliance risks. We cover the most common coding and billing mistakes along with best practices to identify where […]
Billing Errors, Coding Errors, Documentation
The MGMA benchmark for accounts receivable days in a well-run medical practice is 30–35 days. If your practice is sitting above 50, you’re leaving real revenue on the table, and the longer those balances age, the harder they are to collect. In our 30+ years managing revenue cycles at Medwave, we’ve seen practices recover six […]
Accounts Receivable Days, Clean Claim Rate, Denial Management, Patient Collections, Reduce AR Days
Medical billers and coders play a critical role in the healthcare revenue cycle. Their work processing medical claims ensures providers receive accurate reimbursement for services rendered. But what can these professionals expect to earn as their billing and coding career progresses? We explore key factors influencing medical billing and coding salaries, average pay ranges, top […]
Best Paying States, Medical Billing and Coding Salaries, Medical Billing Salary, Medical Coding Salary
Verifying a patient’s insurance eligibility and benefits is a critical first step in the medical billing process. Doing it thoroughly and accurately helps prevent claim denials and delays in payment down the road. We reveal proven techniques to verify eligibility and benefits like a seasoned medical billing pro. Insurance Eligibility Verifying insurance eligibility is crucial in […]
Benefits Verification, Claim Submissions, Insurance Eligibility, Smarter Verification, Verify Eligibility
The COVID-19 pandemic has persisted due to the continued emergence of new SARS-CoV-2 variants. As the novel coronavirus has spread globally, mutations in the viral genome have given rise to distinct new strains that present evolving challenges. Variants like Omicron and its sublineages have demonstrated a higher transmissibility and ability to evade immunity compared to […]
BA.2.86, COVID billing, EG.5, FL.1.5.1
How do you know your medical billing operation is performing optimally? Key performance indicators (KPIs) and metrics provide the critical insights. Regularly tracking the right quantitative measures allows you to gain visibility into what’s working, uncover issues early, and identify areas for improvement. We reveal essential medical billing KPIs and metrics every practice should monitor. […]
Billing Metrics, Claim Denial Rate, Clean Claim Rate, Days in A/R, Medical Billing KPIsMedical billing requires a deep understanding of Current Procedural Terminology (CPT) codes. For intensivists, accurate coding is crucial to ensure proper reimbursement for the critical care services they provide. We’ll jump into the realm of intensivist billing and explore the key CPT codes that play a pivotal role. Whether you’re a medical professional or a […]
Critical Care CPT Codes, Critical Care Services, Intensivist CPT Codes, Wound CareIn the realm of medical billing and coding, precision and accuracy are paramount. Hospitalist billing, a specialized area, relies on specific CPT (Current Procedural Terminology) codes to ensure proper reimbursement for services rendered. These codes serve as a universal language that communicates medical procedures and services to insurance companies. In this comprehensive guide, we’ll delve […]
CPT Codes, CPT Codes in Hospitalist Billing, E/M Service, Hospitalist
At Medwave, we are dedicated to providing valuable insights and guidance on detecting and preventing healthcare fraud and abuse. We will equip you with the knowledge and tools necessary to safeguard your organization and patients from these malicious activities. Implementing the strategies outlined below allows you to enhance the integrity of your healthcare services and […]
Detecting Healthcare Fraud, Medicaid Fraud, Medicare Fraud, Phantom billing, Unbundling
What is Payer Enrollment? Payer Enrollment refers to the process through which healthcare providers, such as hospitals, clinics, and individual practitioners, become registered with insurance payers or healthcare plans. It involves submitting the necessary documentation and information to establish a contractual relationship with these payers. Enrolling with payers allows providers to gain the ability to […]
Centralizing Documentation, Continuous Monitoring, Provider Enrollment, Revenue Cycle Management
There is a growing need for automation to streamline and optimize medical billing operations. Robotic Process Automation (RPA) has emerged as a game-changing technology in the field of medical billing. We highlight the importance of robotic process automation in medical billing and its potential benefits for healthcare organizations. What is Robotic Process Automation (RPA) in […]
Billing Automation, Revenue Cycle Management, Robotic Process Automation, RPA
Substance abuse treatment plays a crucial role in addressing addiction and supporting individuals on their path to recovery. Alongside the provision of quality care, it is essential to have a streamlined billing process to ensure efficient reimbursement for the services rendered. This article aims to explore the common Current Procedural Terminology (CPT) codes used in […]
CPT Codes, Family Therapy Codes, Group Therapy Codes, Psychotherapy Codes, Substance Abuse Billing CPT CodesMedical billing plays a critical role in the healthcare industry, ensuring accurate reimbursement for services provided by healthcare providers. However, the traditional processes of medical billing have long been plagued by challenges such as complex coding systems, frequent changes in regulations, and increasing administrative burden. Medical billing holds great promise in transforming this essential aspect […]
Automation, Blockchain Technology, Machine Learning, Patient-Centric Billing Systems, Predictive Analytics, Real-Time Claims Processing
Urgent care clinics have become an increasingly popular option for patients seeking prompt medical attention for non-life-threatening conditions. These facilities provide convenient, affordable, and timely care for a wide range of illnesses and injuries that are too severe to wait for a scheduled appointment but not serious enough to warrant a visit to the emergency […]
Articles, Billing, Billing Codes, E/M codes, E/M coding, Healthcare, Healthcare Billing, ICD-10, ICD-10 coding, Medical Billing, Medical Billing and Coding, Procedural Codes, Procedure Modifiers, Urgent Care Billing, Urgent Care CPT Codes, Urgent Care Diagnosis Codes, Urgent Care Modifiers
Are you passionate about healthcare administration and interested in pursuing a career in medical billing and coding? As the demand for skilled professionals in this field continues to grow, it’s crucial to choose the right educational institution that provides comprehensive training and prepares you for a successful career. We take a look at some of […]
American Academy of Professional Coders, DeVry University, Drexel University, Keiser University, Medical Coding Training, University of Phoenix
An Explanation of Benefits (EOB) plays a crucial role in helping patients understand the costs and coverage associated with their healthcare services. An EOB is a document that provides a detailed breakdown of a medical claim, outlining the services rendered, the amount billed, the insurance coverage, and the patient’s financial responsibility. Let’s delve deeper into […]
Billing, EOB, EOBs, Explanation of Benefits, Explanation of Benefits (EOBs), Explanation of Medical Benefits, Healthcare, Healthcare Billing, Medical, Medical Billing, OMB, OMBsIn the complex world of healthcare, managing the business side of things can often be overwhelming, especially for those new to the field. One common question that arises is the distinction between medical billing and revenue cycle management (RCM). Although the term “medical billing” has been around for a long time, RCM encompasses the entire […]
CPT, Healthcare, Healthcare Billing, ICD, Medical, Medical Billing, Medical Billing Service, Medical Billing Software, Medical Credentialing, RCM, Revenue Cycle, Revenue Cycle Management
Integrating behavioral health services with primary care has become increasingly important. Recognizing the significance of this integration, the American Medical Association (AMA) has developed specific Current Procedural Terminology (CPT) codes to facilitate the billing and reimbursement process for behavioral health integration (BHI) services. By comprehending and effectively utilizing these codes, healthcare providers can maximize their […]
Behavioral Health Integration, BHI, BHI Services, CCM, Chronic Care Management, CPT Code, CPT Code 99484, CPT Code G0511, Federally Qualified Health Centers, Federally Qualified Health Centers (FQHCs), FQHCs, G0511, RHCs, Rural Health Clinics, Rural Health Clinics (RHCs)