Billing & Credentialing Cranberry Twp. (Pittsburgh)
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Call: (412) 219-4789 | Fax: (866) 422-9277
  • Credentialing
  • Payer Contracting
  • Rate Negotiations
  • Medical Billing
  • Specialties
    • Behavioral Health
    • Toxicology
    • Genetic Testing
    • Pharmacogenetic (PGx) Testing
    • COVID-19 Testing
    • Allergy Testing
    • Skilled Nursing Facilities
    • Urgent Care
    • Oncology
    • Pathology
    • OBGYN
    • Biologics and Specialty Drugs
    • Telestroke and Teleneurology
    • Remote Patient Monitoring
    • Remote Therapeutic Monitoring
    • Home Infusion Therapy
    • Speech Therapy
    • DME
    • Substance Abuse
    • Sleep Study Labs
    • Physical Therapy (PT)
    • Occupational Therapy
  • Blog
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Common Denial Codes in Medical Billing

October 20, 2024 / admin / Articles, Billing Denial Codes, Claim Denials, CO109, CO11, CO119, CO133, CO150, CO16, CO18, CO197, CO204, CO22, CO234, CO24, CO252, CO27, CO31, CO32, CO50, CO55, CO56, CO97, Coding, Common Denial Codes, Denials, Denied Claims, Eligibility Denial Codes, Medical Necessity Denial Codes, Payer-Specific Denial Codes, Registration Denial Codes
Denial Management Resource

Medical billing is a complex process that requires precision, attention to detail, and a thorough understanding of various codes and regulations. One of the most frustrating aspects of this process is dealing with claim denials. These denials can occur for numerous reasons, often represented by specific denial codes. Understanding these codes is crucial for healthcare […]

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Billing Denial Codes, Claim Denials, CO109, CO11, CO119, CO133, CO150, CO16, CO18, CO197, CO204, CO22, CO234, CO24, CO252, CO27, CO31, CO32, CO50, CO55, CO56, CO97, Coding, Common Denial Codes, Denials, denied claims, Eligibility Denial Codes, Medical Necessity Denial Codes, Payer-Specific Denial Codes, Registration Denial Codes

Efficient Modifier Usage Streamlines Billing Success

October 19, 2024 / admin / Articles, Billing, Billing Codes, Coding, Coding and Billing, Medical Billing, Medical Coder, Medical Coding, Modifier 22, Modifier 25, Modifier 26, Modifier 50, Modifier 51, Modifier 59, Modifier TC
Crazy Medical Coder Biller

Efficient and accurate billing practices are essential for maintaining the financial health of healthcare providers and ensuring proper reimbursement for services rendered. One key element in optimizing medical billing processes is the effective use of modifiers. These two-digit codes provide additional information about medical procedures and services, allowing for more precise billing and reducing the […]

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billing, Billing Codes, Coding, Coding Accuracy, coding and billing, Medical Billing, Medical Coder, medical coding, Medical Coding Accuracy, Modifier, Modifier 22, Modifier 25, Modifier 26, Modifier 50, Modifier 51, Modifier 59, Modifier TC

Will Medical Billing and Coding Be Replaced by AI?

October 18, 2024 / admin / AI, AI Bot, AI Coding, AI in Healthcare, AI into RCM, AI Medical Coding, AI RCM, AI-driven RCM, Articles, Artificial Intelligence, Biling Codes, Coding, Coding Accuracy, Coding and Billing
AI in Medical Billing and Coding

The healthcare industry is undergoing a rapid transformation, driven by technological advancements and the increasing adoption of artificial intelligence (AI). One area that has garnered significant attention is medical billing and coding, a crucial component of healthcare administration. As AI continues to evolve and demonstrate its capabilities in various sectors, many wonder: will medical billing […]

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AI, AI Bot, AI Coding, AI in Healthcare, AI into RCM, AI Medical Coding, AI RCM, AI-driven RCM, artificial intelligence, Biling Codes, Coding, Coding Accuracy, coding and billing

Revenue Revolution: Transforming Your Billing Practices

October 17, 2024 / admin / Articles, Artificial Intelligence, Automated Billing, Automation, Billing, Data Analytics, Data Integration, Data Interoperability, Interoperability, Manual Billing, Medical Billing
Revenue Cycle Management Coins

The way companies handle their billing processes can make or break their success. As organizations strive to stay competitive and meet evolving customer expectations, transforming billing practices has become a critical imperative. We’ll reveal the intricacies of modern billing systems, highlighting innovative strategies and technologies that can revolutionize your revenue management. The Importance of Effective […]

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artificial intelligence, automated billing, Automation, billing, Billing Challenges, Data Analytics, Data Integration, Data Interoperability, Interoperability, Manual Billing, Medical Billing

Billing Jenga: Pulling Out the Right Codes Without Toppling the Tower

October 16, 2024 / admin / Articles, Billing Jenga, Claims Generation, Claims Transmission, Financial Responsibility, Jenga, Medical Billing, Medical Billing and Coding, Monitor Claim Adjudication, Patient Registration, Statement Follow-up, Statement Preparation, Superbill Creation
Jenga Billing

Precision is paramount, in the world of medical billing and coding. Each code represents a block in a complex tower of claims, and one misplaced or incorrectly removed code can cause the entire structure to come crashing down. This delicate balance is reminiscent of the popular game Jenga, where players must carefully extract blocks without […]

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Billing Jenga, Claims Generation, Claims Transmission, Financial Responsibility, Jenga, Medical Billing, Medical Billing and Coding, Monitor Claim Adjudication, Patient registration, Statement Follow-up, Statement Preparation, Superbill creation

From Denials to Dollars: Effective Appeal Strategies

October 15, 2024 / admin / Articles, Denial Codes, Denial Management, Denial Management Process, Denial Prevention Strategy, Denial Trends, Denial vs Rejection, Denials, Denied Claims, Denied Medical Claims
Denial Management Resource

Denials are an unfortunate reality, in the world of insurance claims and medical billing. However, a denial doesn’t have to be the end of the road. With the right approach and effective appeal strategies, it’s possible to turn these denials into approvals and recover rightful reimbursements. We’ll explore the art and science of appeals, providing […]

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Denial Codes, denial management, Denial Management Process, Denial Prevention Strategy, Denial Trends, Denial vs Rejection, Denials, denied claims, denied medical claims

Differences Between Credentialing, Privileging, and Enrollment

October 14, 2024 / admin / Articles, Credentialing, Credentialing Accuracy, Enrollment, Healthcare Credentialing, Medical Credentialing, Payer Credentialing, Payer Enrollment, Payer Negotiation, Payor Credentialing, Payor Negotiation, Privileging, Provider Enrollment
Credentialing Expert

Three critical processes play a pivotal role in ensuring the quality, safety, and efficiency of patient care: credentialing, privileging, and enrollment. While these terms are often used interchangeably, they represent distinct yet interconnected procedures that healthcare organizations must navigate to maintain compliance, mitigate risks, and optimize their operations. Understanding the nuances of each process is […]

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Credentialing, Credentialing Accuracy, enrollment, healthcare credentialing, medical credentialing, Payer Credentialing, Payer enrollment, Payer Negotiation, Payor Credentialing, Payor Negotiation, Privileging, Provider Enrollment

What is a Clean Claim Rate?

October 12, 2024 / admin / Articles, Billing, Billing KPIs, CCR, Claim Denial, Claim Denial Prevention, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Clean Claim Rate, Revenue Cycle, Revenue Cycle Management
electronic-claim-attachments

In healthcare revenue cycle management, few metrics carry as much weight as the Clean Claim Rate (CCR). This crucial key performance indicator (KPI) serves as a fundamental measure of a healthcare organization’s billing efficiency and effectiveness. As healthcare providers face increasing pressure to optimize their revenue cycles while maintaining high-quality patient care, understanding and improving […]

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billing, Billing KPIs, CCR, Claim Denial, claim denial prevention, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Clean Claim Rate, Revenue Cycle, Revenue Cycle Management

A Guide to Provider Credentialing with Cigna

October 11, 2024 / admin / Articles, Cigna, Cigna Credentialing, Credentialing, Credentialing Accuracy, Credentialing with Cigna, Medical Credentialing, Medical Recredentialing, Provider Recredentialing, Recredentialing
Guide to Provider Credentialing with Cigna

Provider credentialing is an essential process for healthcare professionals looking to join insurance networks. We discuss the credentialing process with Cigna, one of the leading health insurance providers in the United States. Understanding and successfully navigating this process is crucial for healthcare providers seeking to expand their practice and serve Cigna’s member population. Overview of […]

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Cigna, Cigna Credentialing, Credentialing, Credentialing AI, Credentialing and Contracting, Credentialing New Providers, credentialing on-boarding, Credentialing with Cigna, healthcare, medical credentialing, Revenue Cycle Management

A Guide to Provider Credentialing with Aetna

October 10, 2024 / admin / Aetna, Aetna Credentialing, Articles, Credentialing, Credentialing AI, Credentialing and Contracting, Credentialing New Providers, Credentialing On-Boarding, Credentialing with Aetna, Medical Credentialing, Recredentialing
Guide to Provider Credentialing with Aetna

Provider credentialing is a critical process in the healthcare industry that ensures medical professionals meet specific standards of education, training, and experience before they can join an insurance network. We inspect the intricacies of credentialing with Aetna, one of the largest health insurance providers in the United States, offering valuable insights for healthcare providers seeking […]

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Aetna, Aetna Credentialing, Credentialing, Credentialing AI, Credentialing and Contracting, Credentialing New Providers, credentialing on-boarding, Credentialing with Aetna, healthcare, medical credentialing, Revenue Cycle Management

How Long Does Medical Credentialing Take?

October 9, 2024 / admin / Articles, CAQH, Credentialing, Credentialing Accuracy, Credentialing and Contracting, Credentialing Difficulty, Credentialing On-Boarding, Credentials Verification Organizations, CVO
Medical Credentialing Woman

Medical credentialing is a crucial but often time-consuming process that healthcare providers must undergo to verify their qualifications and ensure patient safety. We explore the various factors that influence credentialing timelines, typical durations, and strategies to expedite the process. Understanding Medical Credentialing Medical credentialing is the systematic process of verifying the qualifications of healthcare providers, […]

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CAQH, Credentialing, Credentialing Accuracy, Credentialing and Contracting, Credentialing Difficulty, credentialing on-boarding, Credentials Verification Organizations, CVO

Are Medical Billing Codes Universal?

October 8, 2024 / admin / Artificial Intelligence, Billing Codes, Billing KPIs, Billing Outcomes, Blockchain, ICD, ICD Codes, ICD-10, ICD-10 to ICD-11, ICD-11, IHTSDO, Non-Universality Coding, SNOMED CT
Female Medical Coder

Medical billing codes are the backbone of healthcare administration worldwide, serving as a standardized way to communicate diagnoses, procedures, and treatments between healthcare providers, insurers, and government agencies. However, the question of whether these codes are truly universal is complex and multifaceted. We dissect the various medical coding systems used globally, their similarities and differences, […]

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billing, CPT, CPT codes, EHR, EMR, Healthcare Billing, ICD-10, ICD-10 coding, ICD-11, IHTSDO, Medical Billing, Non-Universality Coding, outsourced billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA, SNOMED CT, Systematized Nomenclature of Medicine, Value Based Care

Where Should Providers Focus their Billing Resources?

October 7, 2024 / admin / Articles, Medical Billing, Medical Billing AI, Patient Experience, Patient Registration, Patient Responsibility, Practice Management, Prior Authorization, RCM, Revenue Cycle Automation, Robotic Process Automation, RPA
Medical Billing Resources

Effective medical billing is crucial for the financial health and sustainability of healthcare providers. With limited resources and increasing administrative burden, providers must strategically allocate their billing resources to maximize revenue while maintaining compliance and patient satisfaction. This analysis explores key areas where healthcare providers should focus their medical billing efforts to optimize outcomes and […]

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Medical Billing, Medical Billing AI, Medical Billing Tips, Medical Billing Trends, Patient Experience, Patient registration, Patient Responsibility, Practice Management, prior authorization, rcm, Revenue Cycle Automation, Revenue Cycle Management, Robotic Process Automation, RPA

How do CPT® Codes Work?

October 5, 2024 / admin / Articles, Billing Codes, Coding, Coding Accuracy, Coding and Billing, Coding and Documentation, Coding Errors, Coding Intricacies, CPT, CPT Codes, CPT Definitions, Current Procedural Terminology
Medical CPT Codes

Current Procedural Terminology (CPT®) codes are the backbone of medical billing in the United States healthcare system. These standardized codes, maintained by the American Medical Association (AMA), serve as a universal medical language for reporting medical, surgical, and diagnostic procedures and services to entities such as insurance companies, accreditation organizations, and government programs. We go […]

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Billing Codes, Coding, Coding Accuracy, coding and billing, Coding and Documentation, Coding Errors, Coding Intricacies, CPT, CPT codes, CPT definitions, Current Procedural Terminology

Medical Billing AI and Automation Trends to Watch

October 4, 2024 / admin / AI, AI Coding, AI in Healthcare, AI into RCM, AI Medical Coding, AI Models, Articles, Artificial Intelligence, Automated Billing, Automation, NLP, Predictive Analytics, Robotic Process Automation, RPA, RPA Adoption
Robotic Process Automation (RPA) Medical Billing

The healthcare industry is undergoing a dramatic transformation, and medical billing is at the forefront of this revolution. As healthcare providers face mounting pressure to reduce costs while improving patient care, artificial intelligence (AI) and automation technologies are emerging as powerful solutions to streamline the complex, time-consuming process of medical billing. We scan the current […]

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AI, AI Coding, AI in Healthcare, AI into RCM, AI Medical Coding, AI Models, Articles, artificial intelligence, automated billing, Automation, NLP, Predictive Analytics, RPA, RPA Adoption

Key Mechanisms Used in Behavioral Health Billing

October 1, 2024 / admin / Articles, Behavioral Health, Behavioral Health Billing, Behavioral Health Codes, Behavioral Health CPT Codes, Behavioral Health Integration, Billing, CPT, CPT Codes, CPT Definitions, EDI, Electronic Data Interchange, HIPAA
Key Behavioral Health Billing Mechanisms

Behavioral health billing is a complex and crucial aspect of the healthcare industry, specifically focused on mental health and substance abuse services. It involves intricate processes, numerous codes, and strict regulations to ensure accurate reimbursement for services provided while maintaining patient privacy and data security. We research the various mechanisms used in behavioral health billing, […]

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Behavioral Health, Behavioral Health Billing, Behavioral Health Codes, Behavioral Health CPT Codes, Behavioral Health Integration, billing, CPT, CPT codes, CPT definitions, EDI, Electronic Data Interchange, HIPAA

10 Medical Billing and Coding Certifications to Consider

September 30, 2024 / admin / AAPC, Articles, Billing, Billing Codes, Billing Staff, Coding, Coding Accuracy, Coding and Billing, Coding and Documentation, Coding versus Billing, CPMA, Medical Billing, Medical Billing and Coding, Medical Billing and Coding FAQs, Medical Billing and Coding Salaries, Medical Billing Careers
Medical Billing Coding and Certifications

Medical billing and coding professionals play a crucial role in ensuring accurate record-keeping, proper reimbursement, and smooth operations within healthcare facilities. As the demand for skilled professionals in this field continues to grow, obtaining relevant certifications can significantly enhance your career prospects and earning potential. This blog post explains 10 of the most valuable medical […]

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AAPC, billing, Billing Codes, Billing Staff, Coding, Coding Accuracy, coding and billing, Coding and Documentation, Coding versus Billing, CPMA, Medical Billing, Medical Billing and Coding, Medical Billing and Coding FAQs, Medical Billing and Coding Salaries, Medical Billing Careers

Managing Patient Financial Responsibility, While Maintaining High-Quality Care

September 29, 2024 / admin / Articles, Patient Billing, Patient Care, Patient Experience, Patient Financial Responsibility, Patient Flow, Patient Insurance Eligibility, Patient Medical Billing, Patient Responsibility, Patient Satisfaction, Patient-Centered Medical Home, Patient-Centric, Patient-Centric Billing Systems, Patient-Friendly
Happy Healthcare Patient

Healthcare providers face the dual challenge of delivering exceptional patient care while effectively managing the financial aspects of their practice. As healthcare costs continue to rise and patients bear an increasing share of these expenses, it’s crucial for providers to implement strategies that balance financial sustainability with the commitment to high-quality care. We inspect the […]

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Patient Billing, Patient Care, Patient Collections, Patient Costs, Patient Dissatisfaction, Patient Experience, Patient Financial Responsibility, Patient Medical Billing, Patient Responsibility, patient satisfaction, Patient-Centered Medical Home, Patient-Centric, Patient-Centric Billing Systems, Patient-Friendly

Patient Financial Responsibility

September 24, 2024 / admin / Articles, Patient Billing, Patient Care, Patient Collections, Patient Costs, Patient Dissatisfaction, Patient Experience, Patient Financial Responsibility, Patient Medical Billing, Patient Responsibility, Patient Satisfaction, Patient-Centered Medical Home, Patient-Centric, Patient-Centric Billing Systems, Patient-Friendly
Medical Doctor Costs

Managing Increasing Patient Out-of-Pocket Costs and Improving Collections The healthcare landscape in the United States has undergone significant changes in recent years, with one of the most notable shifts being the increasing financial burden placed on patients. As insurance companies and employers look to control costs, patients are facing higher deductibles, copayments, and out-of-pocket expenses. […]

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Patient Billing, Patient Care, Patient Collections, Patient Costs, Patient Dissatisfaction, Patient Experience, Patient Financial Responsibility, Patient Medical Billing, Patient Responsibility, patient satisfaction, Patient-Centered Medical Home, Patient-Centric, Patient-Centric Billing Systems, Patient-Friendly

Understanding Urgent Care Billing

September 23, 2024 / admin / Articles, Billing, Medical Billing, Medical Billing and Coding, Urgent Care, Urgent Care Billing, Urgent Care Center, Urgent Care CPT Codes, Urgent Care Diagnosis Codes, Urgent Care Modifiers
Urgent Care CPT Codes

Urgent care centers have become an increasingly popular option for patients seeking immediate medical attention for non-life-threatening conditions. These facilities bridge the gap between primary care physicians and emergency rooms, offering convenient, accessible care without the need for an appointment. However, the billing processes for urgent care services can be complex and often confusing for […]

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billing, Medical Billing, Medical Billing and Coding, Urgent Care, Urgent Care Billing, Urgent Care Center, Urgent Care CPT Codes, Urgent Care Diagnosis Codes, Urgent Care Modifiers

For Medical Billers, Coding Accuracy is Valued Above All

September 21, 2024 / admin / Articles, Coding, Coding Accuracy, Coding and Billing, Coding and Documentation, Coding Intricacies, Coding versus Billing, Medical Coder, Medical Coders, Medical Coding, Medical Coding Accuracy, Medical Coding Quality
Female Medical Coder

Medical billing stands as a crucial link between healthcare providers and payers. At the heart of this process lies a fundamental principle that every medical biller must embrace: the paramount importance of accuracy in coding. We delve deep into why coding accuracy is not just a best practice, but an absolute necessity in medical billing, […]

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billing, Coding, Coding Accuracy, coding and billing, Coding and Documentation, Coding Intricacies, Coding versus Billing, Medical Billing, Medical Coder, Medical Coders, medical coding, Medical Coding Accuracy, Medical coding quality, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization

How AI is Improving Medical Coding Accuracy and Efficiency

September 19, 2024 / admin / AI, AI Bot, AI Coding, AI in Healthcare, AI into RCM, AI Medical Coding, AI Models, AI RCM, AI-driven RCM, Articles, Coding, Coding and Billing, Medical Coding, Natural Language Processing
AI in RCM

Accurate and efficient medical coding is crucial for proper billing, reimbursement, and overall patient care. As the healthcare industry continues to evolve, artificial intelligence (AI) is emerging as a game-changing technology in the field of medical coding. We inspect how AI is revolutionizing the medical coding process, improving accuracy, and boosting efficiency in ways that […]

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AI, AI Bot, AI Coding, AI in Healthcare, AI into RCM, AI Medical Coding, AI Models, AI RCM, AI-driven RCM, Coding, coding and billing, medical coding, Natural Language Processing

Value-Based Care: Transforming Healthcare Delivery and Outcomes

September 16, 2024 / admin / Articles, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing
Value-Based Care Models Woman

The healthcare industry is undergoing a significant transformation, shifting from traditional fee-for-service models to a more patient-centric, outcome-focused approach known as Value-Based Care (VBC). This paradigm shift represents a fundamental change in how healthcare is delivered, measured, and reimbursed. Value-Based Care aims to improve patient outcomes while simultaneously reducing healthcare costs, creating a win-win situation […]

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Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing

Medical Billing Consulting

September 14, 2024 / admin / Articles, Billing, Billing Case Studies, Billing Consultancy, Billing Consultant, Billing Partnership, Medical Billing, Medical Billing Case Studies, Medical Billing Consultancy, Medical Billing Consulting, Medical Billing Partnership
Medical Billing Consultant

Medical billing stands as a critical component that can make or break a healthcare provider’s financial stability. As regulations become more intricate and reimbursement models shift, many healthcare organizations find themselves struggling to navigate the labyrinth of medical billing. This is where Medwave’s medical billing consulting services step in, offering a beacon of hope and […]

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billing, Billing Case Studies, Billing Consultancy, Billing Consultant, Billing Partnership, Medical Billing, Medical Billing Case Studies, Medical Billing Consultancy, Medical Billing Consulting, Medical Billing Partnership

Medical Coding vs. Medical Billing: Understanding Their Difference

September 13, 2024 / admin / Articles, Billing, Billing Codes, Coding, Coding and Billing, Coding versus Billing, Healthcare Billing, Healthcare Revenue, Medical Billing, Medical Billing and Coding, Medical Coder, Medical Coding
Coding versus Billing

Two crucial roles often cause confusion due to their interconnected nature: medical coding and medical billing. While both are essential components of the healthcare revenue cycle, they involve distinct responsibilities, skill sets, and career paths. We aim to demystify these professions, highlighting their differences, similarities, and importance in the healthcare industry. Introduction to Medical Coding […]

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billing, Billing Codes, Coding, coding and billing, Coding versus Billing, Healthcare Billing, Healthcare Revenue, Medical Billing, Medical Billing and Coding, Medical Coder, medical coding
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Practices Served

  • Behavioral Health
  • Genetic Testing
  • Pharmacogenetic (PGx) Testing
  • Toxicology
  • COVID-19 Testing
  • Allergy Testing
  • Skilled Nursing Facilities
  • Urgent Care
  • Oncology
  • Pathology
  • OBGYN
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Speech Therapy
  • Substance Abuse
  • DME
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy

Practices Served

  • Behavioral Health
  • Genetic Testing
  • Pharmacogenetic (PGx) Testing
  • Toxicology
  • COVID-19 Testing
  • Allergy Testing
  • Skilled Nursing Facilities
  • Urgent Care
  • Oncology
  • Pathology
  • OBGYN
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Speech Therapy
  • Substance Abuse
  • DME
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy

Recent Posts

  • Healthcare Provider Data Management

    What is Healthcare Provider Data Management?

  • Credentialing Needed Female Medical Doctor

    Medicare Modifiers: a Complete Guide

  • White Male Medical Doctor Holding Stethoscope

    Competency-Based Credentialing in Healthcare

  • White Male Medical Doctor Needs Credentialing

    The Worst Credentialing Problems and How to Solve Them

  • Asian Male Doctor in Need of Credentialing

    What are the Main Types of Medical Credentials?

  • California Medical Billing, Credentialing

    Managing California’s Medical Billing and Credentialing Needs

  • Top 10 Highest Paying Medical Credentialing Jobs

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