With nearly 30 million residents, Texas maintains the second largest state population in the country. This burgeoning community includes diverse urban metropolises like Dallas, Houston, San Antonio and Austin as well as remote rural towns and border communities. The variability in patient demographics and healthcare access models across Texas locations generates pronounced impacts on medical […]
Navigating the Complexities of Medical Billing Services in Florida
With over 21 million residents, Florida maintains one of the largest and most demographically diverse state populations across the country. This presents unique dynamics around healthcare delivery and insurance for which medical billing service providers must adapt. From an aging population to an influx of northern transplants, to the millions relying on government insurance plans […]
Billing Services Florida, Florida Billing, Florida Billing Services, Florida Medical Billing, healthcare, Healthcare Billing, Medicaid HMO, Medical, Medical Billing, Medical Billing Service, Medicare Advantage, Miami Medical Billing, Orlando Medical Billing, Revenue Cycle Management, revenue cycle optimization, Tampa Medical BillingBrace for Impact: Managing the Surge of New Medical Billing Regulations
As US healthcare costs continue rising steeply – now over $4 trillion representing nearly 20% of GDP – both federal and state policymakers urgently seek ways to contain runaway expenditure growth. This drive manifests through expansion of programs like Medicare Advantage and Medicaid managed care coupled with accelerating passage of game-changing legislation like No Surprises […]
billing, Billing Best Practice, Billing Disruption, billing revenue, Claim Data, Consumer-Centered Billing, Good Faith Estimates, Health Level 7, healthcare, HL7, Interoperability, medicaid, Medical Billing Regulations, medicare, No Surprises Act, Pre-AuthorizationEvolving Medical Billing Talent Strategies: The Rise of Offshoring and Outsourced Models
Medical billing involves the complex processes of coding services, generating insurance claims, managing rejection disputes, and ultimately securing optimal reimbursement for healthcare providers. With mounting administrative burdens and revenue pressures facing US healthcare systems, demand has accelerated for skilled medical billing talent. However, tight labor markets have spurred shortages. This article explores spreading adoption of […]
healthcare, Healthcare Billing, HIPAA, HIPAA Compliant, HL7, Medical, Medical Billing, Offshore Billing, Outsource Medical billing, outsourced billing, outsourced medical billing, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPADecoding Medical Claims: an Introductory 101 Guide
Navigating insurance claims represents one of the most vital yet complex aspects of running a successful medical practice. Claim submission impacts cash flow, revenue realization, and provider satisfaction. For staff new to healthcare administration, the terminology and processes around medical claims can seem confusing. This article will explain the fundamentals in simple terms – from […]
Charge Capture, Claim Denial Rate, Claim Rejection Rate, Claim Transmission, Claims Lifecycle Management, Claims Management Challenges, First Pass Rate, High Claim Volumes, Patient Dissatisfaction, Provider Dissatisfaction, Regulatory Exposure, Suboptimal ClaimsNavigating the Rise in Denials: Strategies for Successful Denial Management in Medical Billing
As healthcare payers implement more rigorous utilization management programs, denial rates on medical claims have been steadily climbing – up to nearly 10-15% on average for practices based on reports. Denials directly impact revenues and practice bottom lines due to the costs of reworking and appealing claims. This article will provide a comprehensive overview of […]
Claim Denials, Denial Codes, denial management, Denial Prevention Strategy, Denial Trends, denied medical claims, healthcare, Healthcare Billing, Medical Billing, Medical Billing Service, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationWhich CPT Codes are Used in Pharmacogenetic (PGx) Testing Billing?
Navigating CPT Coding for Pharmacogenetic (PGx) Testing Reimbursement 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 […]
0119U, 0142U, 81120, 81121, 81162, 81163, 81225, 81231, 81415, 81416, 81425, 81435, 81436, CPT codes, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, PGx, PGx Billing, Pharmacogenetics, Pharmacogenetics Billing, Pharmacogenetics CPT, Pharmacogenetics CPT Codes, rs12777823, SLCO1B1, VKORC1Payer Enrollment vs. Credentialing: Understanding The Differences
What is Payer Enrollment? Payer enrollment is a process by which healthcare providers enroll with insurance companies to receive payment for services rendered. This process involves completing an application, providing necessary documentation, and meeting specific requirements set by the payer. The payer may review the application and documentation to determine if the healthcare provider meets […]
Credentialing, credentialing process, enrollment, healthcare, Medical, medical credentialing, Payer Contracting, Payer enrollmentTelehealth Billing Gets More Complex as Virtual Care Services Expand
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. This […]
(POS) Codes, Chronic care management, Digital Therapeutics, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, rcm, Remote Patient Monitoring, Remote Patient Monitoring (RPM), Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, RPM for Clinical Trials, telehealth, Telehealth Billing, telehealth delivery, telehealth experience, Telemedicine, Wearable IntegrationGetting Paid Faster: Strategies to Improve Cash Flow Cycles
For any medical practice, timely insurance reimbursement is essential for financial viability and supporting smooth practice operations. However, elongated claim payment cycles strain cash flow and necessitate borrowing to cover costs in the interim. This article explores techniques to accelerate payer payments and optimize the speed of the medical revenue cycle. Diagnosing Causes of Lagging […]
Cash Flow Cycles, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, medical billing strategy, rcm, reimbursement, reimbursement rates, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationOutsourcing vs In-House Billing: Pros and Cons for Practices
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? This guide examines the pros and cons of in-house vs outsourced billing to help practices […]
billing, billing services, Claim Billing, healthcare, Healthcare Billing, In-House Billing, Medical, Medical Billing, Medical Billing Cost, outsourced medical billingGrowing Risk of Claim Denials: How to Protect Your Practice
For medical practices, claim denials have always been a fact of life when dealing with health insurers. However, trends show claim denial rates growing year over year, driven by increased utilization management efforts by payers. Denials directly impact practice revenues and the time/costs tied to appealing denials. This article will examine the factors behind increasing […]
Claim Denials, Denial Codes, Denial Prevention Strategy, Denial Trends, Denials, denied medical claims, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Revenue Cycle Management, revenue cycle optimizationImproving Workflow Efficiency with Medical Billing Automation
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 […]
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Healthcare providers today rely on a diverse set of information systems to manage patient data, including electronic health records (EHRs), laboratory information systems (LIS), billing systems, and imaging systems. A major challenge is exchanging information seamlessly across these disparate systems. HL7 provides a framework to facilitate this interoperability through standardized messaging formats and protocols. This […]
Care Record Summary, CCD, CDA, CDA and CCD, Clinical Document Architecture, EHR, EHR API, EHR Interoperability, EHRs, FHIR, HL7, HL7 FHIR, HL7 Standard, HL7 v2.x, HL7 v3.0, IHE, IHE Framework, Interoperability Standards, LIS, PACS, RESTful APIs, RISHow to Choose the Right Medical Billing Software
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 […]
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Medical billing is a complex, numbers-driven process. To elevate revenues and efficiency, healthcare practices must constantly measure, analyze and optimize their medical billing and revenue cycle performance using key metrics. The Importance of Analytics in Medical Billing In the dynamic healthcare landscape, data is king. Medical practices that succeed at leveraging data make better decisions […]
CPT Code, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Analytics, Medical Billing Service, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process AutomationThe Latest Changes to ICD-10 Codes and How They Affect Billing
ICD-10 Codes 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 […]
CPT-10, healthcare, Healthcare Billing, ICD-10, ICD-10 Code Changes, ICD-10 coding, ICD-10 Update, Medical, Medical Billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationTop Coding and Billing Errors to Avoid
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. This comprehensive guide covers the most common coding and billing mistakes along with best practices to […]
Authorization Failures, Bad Sequencing, Benefits Errors, billing, Billing Duplicates, Duplicate Coding, Duplication, EOB Errors, Expired Policy Numbers, Grouping Errors, Inaccurate Patient Info, Inaccurate Patient Information, Inadequate Specificity, Incorrect Code Assignments, Incorrect Units, Insufficient Modifiers, Invalid Linkages, Invalid Place of Service, Medical Billing, Missing Codes, Missing Modifiers, Poor Handwriting, Timed Coding Errors, Timeliness Issues, Unbundling, UpcodingStrategies for Reducing Accounts Receivable Days and Improving Collections
For any medical practice, keeping accounts receivable cycles short and patient collections high is critical for unlocking the path to financial health. When reimbursement lags become excessive or collection rates decline, financial pressures mount quickly. This comprehensive guide covers key strategies and best practices to shorten accounts receivable days, boost patient payments, and strengthen the […]
A/R, A/R Process, A/R Recovery, Accounts Receivable, Accounts Receivable Recovery, AR, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, medical billing strategy, Revenue Cycle Management, revenue cycle optimizationA Comprehensive Overview of Medical Billing and Coding Salaries
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? This article explores key factors influencing medical billing and coding salaries, average pay ranges, […]
billing, healthcare, Healthcare Billing, Medical, Medical Biller, Medical Billing, Medical Billing and Coding Salaries, Medical Billing Salary, Medical Coder, Medical Coding SalaryHow to Verify Insurance Eligibility and Benefits Like a Pro
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. This guide covers proven techniques to verify eligibility and benefits like a seasoned medical billing pro. Insurance Eligibility Verifying insurance eligibility is […]
Benefits Verification, Eligibility, healthcare, Healthcare Billing, Insurance Eligibility, Medical Billing, Medical Billing Service, medical billing strategy, Outsource Billing, Outsource Medical billing, outsourced billing, outsourced medical billing, Outsourced Verification, Revenue Cycle Management, revenue cycle optimization, Smarter Verification, Verify Eligibility, Verify Insurance EligibilityBilling for Treatment of New COVID-19 Variants (EG.5, FL.1.5.1 and BA.2.86)
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, BAC886, Corona billing, Corona variants, Corona Virus, Corona virus billing, Coronavirus, Covid, COVID billing, COVID-19, COVID-19 variants, EG.5, FL.1.5.1, GXX11, GXX12, Quevir ZD584, SARS-CoV-2, U18.3, U18.4, U18.5Credentialing New Providers? Don’t Forget These Crucial Steps
Adding new providers to your practice brings growth opportunities, but also important billing considerations. Navigating payor credentialing, enrollment paperwork, and proper system setup keeps revenue flowing smoothly for new clinicians. This guide covers key steps medical billers / credentialers should take when onboarding new providers to ensure claims pay as expected. Why Provider Credentialing Matters […]
Credentialing, Credentialing AI, Credentialing New Providers, credentialing on-boarding, EHR, FTP, healthcare, Medical, medical credentialing, Payer enrollment, Pre-screening, Revenue Cycle Management, revenue cycle optimizationMedical Billing KPIs and Metrics Every Practice Should Track
How do you know your medical billing operation is performing optimally? Key performance indicators (KPIs) and metrics provide the critical insights. By regularly tracking the right quantitative measures, you gain visibility into what’s working, uncover issues early, and identify areas for improvement. This guide covers essential medical billing KPIs and metrics every practice should monitor. […]
healthcare, Healthcare Billing, Healthcare KPIs, KPI, KPIs, Medical, Medical Billing, Medical Billing KPIs, Medical Billing Service, Medical KPIs, Revenue Cycle Management, revenue cycle optimizationWhy Medwave is the Best Medical Billing Company for Your Practice
Selecting the right medical billing company is key to ensuring smooth claim processing, optimal reimbursement, and an improved bottom line. As the healthcare revenue cycle becomes more complex, outsourcing to specialists is an increasingly attractive option. In this article, we’ll explore why Medwave rises above the rest as the top medical billing service for providers. […]
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