The healthcare industry is on the cusp of a significant transformation with the introduction of the International Classification of Diseases, 11th Revision (ICD-11). This comprehensive update to the global standard for health data, clinical documentation, and statistical aggregation promises to revolutionize medical billing practices. The key features of ICD-11 and its potential impacts on the […]
healthcare, ICD, ICD Codes, ICD-10 to ICD-11, ICD-11, International Classification of Diseases, International Classification of Diseases 11th Revision, Medical, Medical Billing, Revenue Cycle Management
Effective January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) introduced four new HCPCS modifiers for Medicare claims: XE, XP, XS, and XU. These modifiers provide more specificity around the circumstances of service provided. Using these new modifiers correctly is essential for ensuring accurate reimbursement. We provide an overview of modifiers XE, XP, […]
CMS, HCPCS, Medicare Modifiers, Modifier XE, Modifier XP, Modifier XS, Modifier Xu, XE, XE: Separate encounter, XP, XP: Separate practitioner, XS, XS: Separate structure, XU, XU: Unusual non-overlapping service
Medical billing and coding is an intricate process that requires the use of different types of codes to accurately document procedures, services, diagnoses, and supplies. Three important types of codes are comprehensive codes, component codes, and modifier codes. Understanding the differences between these code types is crucial for accurate medical billing and reimbursement. Comprehensive Codes […]
-AS, -AT, -CG, -LT, -RT, adjunct services, ancillary services, billing, bundling, care settings, Component Codes, comprehensive codes, CPT Manual, healthcare, Healthcare Billing, laterality, Medical, Medical Billing, Modifier Codes, Modifiers, patient conditions, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Unbundling, unusual circumstances
Electronic health records (EHRs) have become a core component of healthcare operations. When used effectively, EHRs can improve care coordination, increase efficiency, and provide valuable data insights. However, many healthcare organizations struggle to fully leverage their EHR investments. Gaps in EHR adoption and usage lead to workflow inefficiencies, poor data quality, and suboptimal care. We’ll […]
care gap identification, Clinical Decision Support Underutilization, Coding Gaps, Data Silos, Data Transparency, EHR, EHR (Electronic Health Records), EHR adoption, EHR gaps, EHR Integration, Electronic Health Records, healthcare, healthcare analytics, Medical, Medical Analytics, Medical workflow inefficiencies, Patient Portal Underutilization, Reporting Limitations
Medical billing is a complex and ever-evolving field. With constant changes in regulations, coding guidelines, reimbursement rates, and technology, medical billing services must continuously adapt and improve to stay competitive. Taking your medical billing to the next level requires focusing on efficiency, optimization, training, and utilizing the latest tools and software. Implementing the strategies outlined […]
clearinghouse, EDI, healthcare, Healthcare Billing, Medical, Medical Billing, medical billing strategy, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, ROI, RPA
Electronic health records (EHRs) have become an indispensable part of healthcare operations. EHRs allow providers to store patient information electronically and share it securely. However, to transmit claims and other data to payers, providers need to connect their EHR system to a clearinghouse. A clearinghouse acts as an intermediary between providers and insurance companies by […]
clearinghouse, EHR, EMR, healthcare, Healthcare Billing, HL7, HL7 interface, HL7 interoperability, HL7 messaging, HL7 Standards, Medical, Medical Billing, Revenue Cycle Management, revenue cycle optimization
At first glance, medical billing and professional sports seem to occupy opposite ends of the career spectrum. However, there are interesting parallels in how these two worlds operate when it comes to finances, data, and competition. Drawing comparisons between the healthcare administration and athletics provides unique insights that billing professionals can apply to enhance their […]
AI, artificial intelligence, Claim Data, Data, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, outsourced billing, outsourced medical billing, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, sports, sports vs billing
The healthcare industry is facing a critical staffing shortage that is impacting medical billing operations and revenue cycle management. With an aging population and expanded access to healthcare, the demand for healthcare services is rising. However, there is a shortage of healthcare workers, including medical billers and coders, to meet this growing demand. This is […]
billing, Billing Staff, COVID billing, COVID-19, healthcare, Healthcare Billing, Medical Billing Staff, medical coding, Outsource Billing, Outsource Medical billing, outsourced billing, outsourced medical billing, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation
Healthcare Expertise Across Technical and Business Domains The healthcare industry is rapidly evolving and becoming more complex. Developing expertise across both technical and business domains is crucial for healthcare organizations to keep up with industry changes and provide high-quality care. Below, we’ll stress the importance of cross-functional expertise in healthcare and provide actionable insights for […]
Cross-functional, Healthcare Business, Healthcare Ecosystem, Healthcare Operations, Healthcare Technology, Healthtech, HL7, HL7 Interfacing, Medical Business, Medical Technology, Medtech, Modern Healthcare, Patient Experience
The healthcare industry has undergone massive changes in recent years, fueled by advances in technology and a shift towards patient-centered care. However, one area that still has untapped potential is the use of Health Level 7 (HL7) standards. HL7 provides a framework for exchanging clinical and administrative data between software applications used by various healthcare […]
billing, EHR, EHR Integration, EMR, EMR Interoperability, Health Level 7, Healthcare HL7, HL7, HL7 adoption, HL7 FHIR, HL7 interface, HL7 interoperability, HL7 messaging, HL7 Standard, HL7 v2.x, HL7 v3.0, HL7-enabled, Medical Billing
Artificial intelligence has moved from hype to mainstream adoption across healthcare, unlocking new possibilities for improving patient outcomes, experiences, and access to care. Below, we’ll explore 12 impactful real-world use cases showing exactly how healthcare providers are leveraging different AI models to enhance clinical workflows, augment decision making, streamline operational processes, and advance precision medicine. […]
AI, AI Diagnostic Models, AI healthcare, AI medical, AI Models, artificial intelligence healthcare, healthcare, Healthcare Artificial Intelligence, HIPAA, HIPAA Compliant, Medical, Medical Artificial Intelligence, Use Case
Medical billing plays a pivotal yet oft-overlooked role in provider financial stability and continuity of care operations. However, limited resources and inadequate solutions burden in-house teams trying to navigate outdated systems. The resulting claim delays, reimbursement leakage, and patient dissatisfaction has brought many practices to a breaking point. While outsourcing presents risks if not properly […]
billing, healthcare, Healthcare Billing, Medical, Medical Billing, outsourced billing, outsourced medical billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA
Medical billing sits at the heart of provider revenue cycles, yet few fully appreciate the complexities billing teams navigate to keep financial flows stable. Between interpreting endless payer policies, wrestling with outdated technology, and managing behind-the-scenes patient communications, it takes specialized skills to turn charges into reimbursements. It serves as the financial backbone of the […]
Healthcare Billing, Healthcare Outcomes, Medical, Medical Billing, Medical Billing Ingredients, Medical Billing Service, Outcomes, outsourced billing, outsourced medical billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA, Secret Sauce
Amidst an increasingly complex healthcare payer environment, medical billing has direct implications on the financial viability of providers to maintain daily operations and invest in advancing care. However, antiquated systems still relying on manual workflows struggle to effectively navigate critical revenue cycle processes and optimization in the modern digital era. The resulting claims denials, patient […]
Robotic Process Automation (RPA) has transformed industries across the globe by automating repetitive, rules-based digital tasks. In recent years, healthcare providers have begun to realize the immense potential benefits RPA can offer their organizations too. Implementing RPA can be a challenging process, but for those willing to invest in change, the payouts are plentiful. Below, […]
AI, artificial intelligence, Automation, Billing Automation, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Automation, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA
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 […]
Austin Medical Billing, Dallas Medical Billing, healthcare, Healthcare Billing, Houston Medical Billing, Medical, Medical Billing, Medical Billing Service, outsourced billing, outsourced medical billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, San Antonio Medical Billing, Texas Care Delivery, Texas Medical Billing
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 Billing
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-Authorization
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. Below, we analyze the spreading adoption […]
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, RPA
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, billing services, Claim Billing, healthcare, Healthcare Billing, In-House Billing, Medical, Medical Billing, Medical Billing Cost, outsourced medical billingHealthcare 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. We […]
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, RISSelecting 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 Data, Billing Software, Billing Software RPA, healthcare, Healthcare Billing, HL7, HL7 Standards, Medical Billing, Medical Billing Integration, Medical Billing Platform, Medical Billing RPA, medical billing software, Robotic Process Automation, RPA, RPA HL7
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 Automation
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 optimization
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. Covering key strategies and best practices to shorten accounts receivable days, boost patient payments, and strengthen the financial fitness of […]
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 optimization