Payer enrollment and credentialing are two separate steps whenever you bring new providers into a medical practice, and mixing them up delays billing. Bringing on a physician, nurse practitioner, or physician assistant opens doors to serving more patients and expanding your services. But there’s a catch that trips up even experienced practice managers, getting these […]
CAQH, DataSpring, Medical Credentialing, Payer Enrollment, Primary Source Verification
“Revenue leakage” describes circumstances wherein a healthcare provider has supplied care to a patient but doesn’t collect payment. In general, it happens when accounts receivable (AR) continue to be unpaid for too long and are inadvertently overlooked. The longer an account receivable remains outstanding, the less likely healthcare providers are to retrieve payment, even in […]
AR Cycles, Medical Billing, Patient Centricity, RCM, Revenue Leakage
An Unethical Medical Billing Behavior Case The case of Dr. Michael Stevens is an illustration of the worst-case scenario when unethical behavior impacts medical billing. An anesthesiologist and owner of a pain management clinic, Dr. Stevens was obliged to relinquish his medical license when it was uncovered that his in-house medical biller was committing fraud. […]
Ethical Medical Billing, Healthcare Ethics, Medical Billing Ethics, Medical Billing Fraud
Patient Collections Strategies FAQ 7 Strategies to Maximize Patient Collections Any medical provider knows how difficult it is to get paid for their services. 73 percent of healthcare providers assert that it takes 30+ days to recover their payment fully. Various issues like complicated billing procedures, changing payer fee schedules, employee attrition, government directives, lack […]
Basics of Medical Billing, Collection Process, Medical Billing, Medical Billing Strategies, Patient Collections
Medical billing issues that cut into provider revenue often start at the front desk. Let’s say a patient comes in and gives you his or her Medicare card. The front desk carefully records the information and billing submits the charge to Medicare. But the claim is rejected, maybe even from the clearinghouse. The problem? The […]
Diagnostic Code, Healthcare Billing, Medical Billing Service, Medical Claims, Outsourced Billing
Outsourcing toxicology billing can help labs maximize revenue collection. As a supplier of toxicology testing, you’re well aware that medical billing for toxicology laboratory work is highly detailed and undergoes frequent and often unpredictable changes. Further muddying the waters, lab testing work is an area of attention and scrutiny by agents for the Office of […]
Billing Revenue, Outsourced Toxicology Billing, Revenue Cycle, Toxicology Billing, Toxicology Lab BillingMedical billing service cost usually lands between 4% and 10% of what your practice collects. That range is wide on purpose, and the gap inside it is where the real money sits. Take a practice that collects $1 million a year. A 5% quote costs $50,000. An 8% quote costs $80,000. Same practice, same claims, […]
Billing Fees, Billing Percentage, Fixed Rate Billing, Medical Billing Cost, Monthly Billing Pricing, Outsourced Billing
Outsourcing allergy billing makes sense because allergy immunotherapy billing runs on a different clock than most specialties. A single patient’s serum can stay in rotation for up to a year, moving through build-up dosing, then maintenance dosing, with the injection codes changing depending on whether the practice is billing single or multiple antigen injections at […]
Allergy Immunotherapy Billing, Immunologist Billing, Immunology Billing, Outsourced Billing
Prior authorization is a requirement no patient or healthcare provider wants to hear about when they are ready to proceed with a doctor-approved procedure. “This procedure will require prior authorization.” However, it’s one of the utilization management tools that insurance companies have encouraged to decide if specific prescribed procedures, services and medications are medically required […]
Billing and Coding, Medical Billing, Prior Authorization Process, Reimbursement, Revenue Cycle Management
Medical credentialing verifies a physician’s qualifications behind the scenes, and many patients know little more about those qualifications than what they see neatly hanging from their office wall. While they’re able to access in-depth background information about their auto mechanic, it’s when they are at their most vulnerable, entrusting their family’s health to a qualified […]
Credentialing Value, NCQA, Outsourced Credentialing, Payer Enrollment, Provider Credentialing
What is Medical Billing? Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider. It involves coding and classification of diseases, procedures, and treatments and submission of claims to insurance companies for reimbursement. The goal of medical billing is […]
Billing Service, Medical Billing Powerpoint, Medical Billing PPT, Medical Billing Video
It’s looming, in the coming months or next year, many financial experts foresee an inevitable economic recession in the United States and elsewhere. A large downturn in the economy will adversely affect the aspect of most people’s lives. Their finances, lifestyle and healthcare. Initially, the effect(s) of a recession on the healthcare sector may not […]
AAFP, COVID, Healthcare
Outsourcing behavioral health medical billing gives providers relief from regulations that keep rolling out additional layers. Healthcare providers are spending more time and resources as they organize patient care, and this time could be put to better use. Using a qualified, outsourced behavioral health billing company can provide better service as your workload reduces, you […]
Behavioral Health Billing, Mental Health, Mental Health Billing, Outsourced Billing
Credentialing for healthcare providers, hospital groups and facilities is a tedious task that often requires a team of specialists to handle all the on-boarding information, as well as updates throughout the year. As of April, 2018, CMS now mandates that providers maintain accurate information and timely updates. Providers and facilities that do not keep up […]
CAQH, Credentialing Applications, In-Network, NPPES, PECOS, Primary Source Verification
MACRA changed Medicare reimbursement by ending a model that used to be fairly simple, where you saw the patient, billed Medicare, and got paid based on volume. That model started to shift back in 2015, when Congress passed the Medicare Access and CHIP Reauthorization Act, better known as MACRA. The law rebuilt the way Medicare […]
Advanced APM, CMS, Medicare, MIPS, QPP, Value-Based Models
Ask ten people in a medical office to explain the difference between billing and credentialing, and you might get ten different answers. Some will say they’re basically the same department. Others will shrug and say “billing is the money part, credentialing is the paperwork part,” which isn’t wrong, but it barely scratches the surface. These […]
Billing vs Credentialing