Let’s jump into a topic that might seem a bit dry at first glance, but trust me, it’s super important, especially if you’re in the healthcare industry. We’re going to be talking about CAQH, and by the end of this blog post, you’ll know everything there is to know about this organization and why it […]
CAQH, CAQH CORE Certification, CAQH Impact, CAQH Index, CAQH ProView System, CORE, Council for Affordable Quality Healthcare, Value Based Care, Value-Based Care Models, Value-Based Models, Value-Based Pricing
Let’s talk about something that might not be the most riveting topic, but is incredibly important, medical provider fee schedules. We know, we know, it sounds about as exciting as watching paint dry. But hear me out, because these fee schedules have a massive impact on the cost of healthcare and how much you end […]
Fee Schedule Comparison, Fee Schedule Landscape, Future of Fee Schedules, healthcare, Healthcare Fee Schedules, Healthcare Outcomes, Healthcare Revenue, Medical, Medical Provider Fee Schedule, rcm, RCM Optimization
Let’s talk about something that might not be the most exciting topic, but it’s absolutely crucial if you want to play ball with the big leagues of healthcare insurance. We’re talking about credentialing. That oh-so-fun process of getting your ducks in a row to prove you’re legit and qualified to provide care to patients covered […]
Credentialing, Credentialing Accuracy, Credentialing Criteria, Credentialing Difficulty, credentialing on-boarding, Get Credentialed, Get In-Network, In-Network Credentialing, Insurance Providers
Few topics get finance teams and medical billing professionals quite as fired up as fee schedules and reimbursement rates. It’s the core of how healthcare providers generate revenue and keep operations humming. At the same time, it’s an arena loaded with complexity, regulatory scrutiny, and often mind-numbing minutiae. If you’re reading this, you’re probably intimately […]
Fee Schedule, Fee Schedules and Reimbursement Rates, Optimizing Reimbursements, reimbursement, Reimbursement Model Shift, Reimbursement Models, Reimbursement Optimization, reimbursement rates, Reimbursement Regulations
Whether you’re a physician, practice manager, or anyone else charged with overseeing the billing operations for a healthcare organization, let me start by saying – I feel your pain. Medical billing has always been one of the most maddeningly complex, persistently stressful parts of running a modern medical practice. In today’s healthcare landscape, it just […]
billing, billing services, Healthcare Billing, HIPAA, HIPAA Compliant, Medical Billing, Medical Billing and Coding, medical billing services, Medical Billing Tips, outsourced billing, outsourced medical billing, Outsourcing Medical Billing
If you’ve ever stepped foot in a medical facility or had any kind of healthcare service, you’ve likely encountered the wonderful world of medical billing. But have you ever stopped to think about the different billing methods used? Specifically, the distinction between institutional billing and professional billing? No? Well, buckle up because we’re about to […]
billing, CPT codes, HCFA-1500, HCPCS Codes, Healthcare Billing, ICD Codes, Institutional Billing, Medical Billing, Medical Billing Lingo, Medical Billing Verbiage, Professional Billing, UB-04, UB-04 Billing
We all know how critical it is to keep a sharp eye on those revenue cycle metrics, right? Those numbers have the power to make or break your financial game. Understand them, optimize them – that’s the difference between rolling in dough or scraping by. But let’s keep it a hundred – digging into revenue […]
rcm, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Cycle Process, revenue optimization
Let’s be real – dealing with credentialing is difficult. No healthcare organization truly wants to maintain or balance it. It’s tedious, time-consuming, and can feel like an endless loop of paperwork and verification. But here’s the thing – it’s absolutely crucial. Proper credentialing ensures that your practitioners are qualified and up-to-date, allowing them to get […]
Credentialing, Credentialing Accuracy, Credentialing AI, Credentialing and Contracting, Credentialing Criteria, Credentialing Difficulty, Credentialing New Providers, credentialing on-boarding, medical credentialing, Medical Credentialing AI
Dealing with denied medical claims is one of the biggest headaches in the healthcare revenue cycle. It’s frustrating, time-consuming, and can put a serious dent in your bottom line if not handled properly. But fear not – we’re here to walk you through the process of identifying denials, filing appeals, and hopefully getting those claims […]
Denial Analytics, Denial Codes, denial management, Denial Trends, denied claims, denied medical claims
If you’re in the healthcare industry or deal with professionals who need to be credentialed, you know how complex and time-consuming the whole process can be. From verifying licenses and certifications to checking work histories and malpractice claims, credentialing is a massive headache that never seems to end. But here’s the thing – you don’t […]
Credentialing, Credentialing Accuracy, Credentialing AI, Credentialing and Contracting, Credentialing New Providers, credentialing on-boarding, medical credentialing, Medical Credentialing AI, rcm, Revenue Cycle, Revenue Cycle Management
In obstetrics and gynecology (OBGYN), accurate medical coding is crucial for proper billing and reimbursement. The Current Procedural Terminology (CPT) codes are a standardized set of codes used to report medical services and procedures performed by healthcare professionals. These codes are maintained by the American Medical Association (AMA) and are updated annually to reflect changes […]
Billing Codes, Codes for OBGYN Billing, Diagnostic Procedures CPT Codes, Evaluation and Management CPT Codes, OBGYN, OBGYN Billing, OBGYN Billing Codes, OBGYN CPT Codes, OBGYN Modifiers, Preventive Care CPT Codes, Surgical Procedures CPT Codes
Healthcare providers, chances are you’re all too familiar with the headaches that come with negotiating contracts with insurance payers. It’s a tedious process that often leaves you feeling like you’re getting the short end of the stick. But here’s the thing – re-negotiating those contracts on a regular basis is absolutely crucial for the financial […]
billing, Contract Negotiations, healthcare, Medical, Medical Billing, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer enrollment, Payer Negotiation, Payer Regulations, rcm, Revenue Cycle, Revenue Cycle Management
If you’re a healthcare provider, dealing with medical billing is probably one of your least favorite parts of the job. It’s tedious, complicated, and takes you away from your real passion – caring for patients. That’s why many practices choose to outsource their medical billing to third-party companies that specialize in it. But what does […]
billing, Billing AI, Billing Analytics, Billing KPIs, billing revenue, Billing RPA, Medical Billing, Medical Billing AI, outsourced billing, outsourced medical billing, Outsourcing, Revenue Cycle Management
So, it’s that time again. Your payer contracts are up for renewal and you need to renegotiate. Maybe you’re feeling like the reimbursement rates they’re offering are way too low. Or the administrative burdens and preauthorization requirements have gotten out of hand. Whatever the reason, you know you need to go back to the negotiating […]
Payer Contract, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer enrollment, Payer Negotiation, reimbursement, Reimbursement Models, reimbursement rates, Renegotiate Payer Contracts
If you’re a healthcare provider, you know how important it is to get paid accurately and on time for the services you provide. But the revenue cycle management process can be a tangled web of codes, documentation requirements, and insurance rules. One of the biggest pain points? Charge capture. Charge capture is the process of […]
billing, Charge Capture, Charge Capture Challenges, Charge Capture Strategy, Denials, EHR, EMR, Medical Billing, Missed Charges, Optimized Charge Capture, Revenue Cycle Management, Revenue Leakage
Home infusion therapy is a treatment option that allows patients to receive intravenous (IV) medications, fluids, or nutrition at home. This approach has become increasingly popular as it offers convenience, promotes patient independence, and reduces healthcare costs associated with prolonged hospital stays. However, to ensure proper reimbursement and accurate billing, healthcare providers must understand and […]
0537T, 0538T, 96360, 96361, 96365, 96366, 96367, 96368, 96372, 96374, Category I Codes, Category II Codes, Diagnostic Injections, Home Infusion Therapy, Home Infusion Therapy Billing, Home Infusion Therapy CPT Codes, Intravenous (IV) Medications CPT Codes, Prophylactic, Therapeutic
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, clearinghouse, EHNAC Accreditation, EHR, EHR Integration, EMR, EMR integration, HIPAA Compliance, HL7, HL7 interoperability, HL7 Standards, Regulatory Compliance, 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 […]
A/R, Billing Tech, Billing Technologies, Business Intelligence, Claim Scrubbing, Data Analytics, Denials, EHR, EMR, KPIs, Patient Portals, RPA, 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 […]
Advanced Beneficiary Notice, G0480, G0481, G0482, G0659, G0660, GC/MS, LC/MS, Medicare Coverage for Toxicology Tests, Medicare Reimbursement, toxicology billing, Toxicology Medicare, Toxicology Medicare Reimbursement, Toxicology Reimbursement Denial, Toxicology Testing, Toxicology Tests
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 […]
APC, APCs, CMS, Geographical Practice Cost Index, healthcare, Healthcare Billing, Inpatient Prospective Payment System, IPPS, Medical, Medical Billing, medicare, medicare billing, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare Physician Fee Schedule, Medicare Reimbursement, Medicare Severity Diagnosis Related Groups, MIPS, MS-DRG, OPPS, Prospective Payment Systems, Revenue Cycle, Revenue Cycle Management
Let’s be real – 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 re-checking codes, filling out endless […]
Automation, Billing Automation, EHR, EMR, EMR Data Extraction, EMR RPA, Medical Billing Automation, Robotic Process Automation, Robotic Process Automation Billing, Robotic Process Automation Medical Billing, RPA, RPA Adoption
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 […]
99091, 99453, 99454, 99457, 99473, 99474, billing, CPT codes, Healthcare Billing, Medical Billing, rcm, Remote Patient Monitoring, Remote Patient Monitoring Billing, Remote Patient Monitoring CPT Codes, Revenue Cycle Management, RPM, 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, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Startup, rcm, RCM Startup, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Start a Medical Billing Company, Start Your Own Medical Billing Company
Let’s face it – claim denials are the bane of every medical practice’s existence. They’re like kryptonite sapping the strength from your revenue cycle. But what if we told you there was a way to turn those denied claims into a money-making superpower? No, we’re not peddling some snake oil solution. I’m talking about adopting […]
billing, Claim Denial Kryptonite, Coding, coding and billing, Denial Kryptonite, Diagnosticians, E&M code, Interventionists, Kryptonite-Proof Strategy, Lex Luthor, Proceduralists, rcm, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management (RCM), TherapistsIf 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, Billing Systemic Reform, Billing Transparency, CMS, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Transparency, No Surprises Act, Revenue Cycle, Revenue Cycle Management