If 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
So you run a medical practice or healthcare facility. Congrats, you’re doing important work that helps keep people healthy. But have you put much thought into your medical billing workflows? If not, you really should. Billing is the lifeblood that keeps a healthcare operation afloat financially. It’s how you get paid for the vital services […]
AI, Automation, billing, Billing Workflows, Financial Visibility, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Workflows, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, RPA
Pathology is a branch of medicine that deals with the study of diseases, particularly through the examination of bodily fluids, tissues, and organs. Pathology services play a crucial role in the diagnosis and management of various medical conditions, and proper coding and billing procedures are essential for reimbursement from insurance companies and other payers. The […]
Anatomic Pathology Consultation, Anatomic Pathology Consultation Codes, Cytology, Cytopathology, Cytopathology CPT Codes, Disease, Electron Microscopy, Immunohistochemistry, Molecular Pathology, Molecular Pathology CPT Codes, Pathology, Pathology Billing, Pathology CPT Codes, Pathology RCM, Surgical Pathology, Surgical Pathology CPT Codes
Denial management has emerged as a critical component for healthcare providers and organizations. As payers become more stringent in their reimbursement policies and regulatory requirements tighten, effective denial management strategies are essential for minimizing revenue leakage and ensuring financial stability. According to industry reports, up to 90% of denied claims are recoverable, representing a significant […]
Administrative Burden, billing, claim denial prevention, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Continuous Process Improvement, Denial Analytics, Denial Codes, denial management, Denial Prevention Strategy, Denial Trends, Denials Managements, denied claims, denied medical claims, Disrupted Cash Flow, Patient Dissatisfaction
Efficient medical billing processes are crucial for maintaining a healthy revenue cycle and to ensure the financial well-being of healthcare providers. With the increasing complexity of payer regulations, coding intricacies, and patient expectations, medical billing workflows can quickly become convoluted and inefficient, leading to costly delays, errors, and dissatisfied patients. Fortunately, through the implementation of […]
billing, Billing Challenges, Billing Workflow, Coding Intricacies, EHR, Electronic Health Records, EMR, Future-Proof, healthcare, Healthcare Billing, Interoperability Standards, Medical, Medical Billing, Medical Billing Service, Medical Billing Workflow, NLP, Payer Regulations, Practice Management Systems, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Streamlined Medical Billing Workflow
The field of genetics has experienced remarkable advancements in recent years, revolutionizing our understanding of human health and disease. Genetic testing, in particular, has become an invaluable tool in the diagnosis, treatment, and prevention of various conditions. However, the rapid pace of innovation has also brought forth a complex landscape of coverage and reimbursement challenges. […]
billing, Coverage and Reimbursement, DNA, DNA Testing, genetic testing, genetic testing billing, Genetic Testing Coverage, Genetic Testing Coverage and Reimbursement, Genetic Testing Reimbursement, Genetics, healthcare, Medical Billing, Medical Billing Service, rcm, Regulatory Bodies, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization
Breast cancer is one of the most common cancers among women in the United States, with about 1 in 8 women developing invasive breast cancer over their lifetime. As breast cancer incidence has increased over the past several decades, advances in screening, diagnosis, and treatment have also greatly improved. Breast cancer death rates have fallen […]
billing, Biomarker Billing, Breast Cancer, Breast Cancer Billing, Breast Cancer Care, Breast Cancer CPT Codes, Breast MRI Billing, Breast Ultrasound Billing, Cancer Billing, Cancer Screening Billing, Chemotherapy Billing, Coding, CPT codes, healthcare, Healthcare Billing, Mammography Billing, Medical, Medical Billing, Medical Billing and Coding, medical coding, rcm, Revenue Cycle, Revenue Cycle Management
Revenue cycle management (RCM) is a crucial part of running any healthcare organization. It involves everything from patient registration and eligibility verification to medical coding, charge capture, claims submissions, payment posting, denial management, and more. The goal is to maximize reimbursements while reducing costs and inefficiencies. In recent years, artificial intelligence (AI) has emerged as […]
AI, AI Bot, AI Coding, AI into RCM, AI RCM, artificial intelligence, Automated Appeal Letters, Automation, billing, healthcare, Healthcare Billing, Machine Learning, Medical, Medical Billing, NLP, rcm, RCM Automation, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization
As the healthcare industry continues to embrace technological innovations, the integration of artificial intelligence (AI) solutions like ChatGPT in Revenue Cycle Management (RCM) holds immense promise for optimizing financial processes and improving operational efficiency. We cover potential applications and challenges associated with leveraging ChatGPT in RCM. Understanding Revenue Cycle Management Before delving into the potential […]
Accounts Receivable, AI-driven RCM, ChatGPT, ChatGPT Healthcare, ChatGPT in Healthcare, ChatGPT in RCM, ChatGPT in Reimbursement, Healthcare AI, Healthcare KPIs, Medical AI, Medical KPIs, OpenAI, Revenue Cycle Management
In the intricate world of medical billing and coding, understanding Common Procedural Terminology (CPT) codes is paramount. These codes act as a universal language, facilitating seamless communication between healthcare providers and insurance entities. Let’s delve into the realm of CPT codes, exploring their significance and shedding light on the most commonly used ones. Decoding CPT […]
Allergy Testing Billing, Behavioral Health Billing, billing, Coding, COVID-19 billing, CPT codes, DME Billing, Family Practice Billing, genetic testing billing, Healthcare Billing, Medical Billing, medical coding, Medical Reimbursement, Occupational Therapy Billing, outsourced billing, PT Billing, Revenue Cycle Management, revenue cycle optimization, speech therapy billing, toxicology billing
Biologics and specialty drugs represent some of the most innovative and complex pharmaceuticals available today. They are used to treat a wide range of diseases and conditions, from cancers to autoimmune disorders. However, these cutting-edge medications also come with high price tags and complex administration requirements. One of the tools used to properly bill and […]
Additional Injectable Drugs, Biologics and Specialty Drugs, CPT Codes for Oral Specialty Drugs, Cytokines, Enbrel, Enzyme-Related Biologics, Hemophilia Clotting Factors, Humira, Immune Globulins, Infusible Biologics, Injectable/Infusible Biologics, Interferons, Monoclonal Antibodies, Remicade, Rituxan, Specialty Drugs
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
Modifier codes are an important part of medical billing and coding. They provide additional information about a medical procedure or service to help ensure proper reimbursement. Knowing when to use modifier codes can improve claim accuracy and prevent costly payment delays or denials. We explain what modifier codes are, why they are used, the most […]
Anatomic Modifiers, Bilateral Surgery Modifiers, billing, Coding, coding and billing, CPT, CPT definitions, CPT-10, Global Surgery Modifiers, HCPCS, healthcare, Healthcare Billing, Medical, Medical Billing, medical coding, medical necessity, NCCI, NCCI Edits, payer policies, Procedure Modifiers, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization
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 circumstancesImproper bundling in medical billing can lead to denied claims, payment delays, audits, fines, and even fraud allegations. As a medical billing professional, it’s crucial to understand how to bundle procedures correctly to ensure proper reimbursement while adhering to CMS guidelines. In this guide, we’ll cover everything you need to know about avoiding improper bundling […]
Claim Denials, Component Codes, Comprehensive Code, CPT, CPT codes, denied claims, denied medical claims, HCPCS, Medically Unlikely Edits, Modifier Codes, MUEs, National Correct Coding Initiative, NCCI, NCCI Edits, Unbundling
Medical practices are constantly looking for ways to improve efficiency and increase revenue. Yet many practices are still relying on manual, paper-based billing processes that are tedious, error-prone, and time-consuming. In today’s digital age, automated medical billing is a must for any practice that wants to streamline operations, get paid faster, reduce denied claims, and […]
AI, artificial intelligence, automated billing, automating billing, billing, Billing Automation, Cloud-based automation, EHR, Healthcare Billing, Medical, Medical Billing, Medical Billing Automation, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA
The healthcare industry in the United States has undergone massive changes in recent decades. One of the most significant shifts has been in how healthcare providers get reimbursed for services. The traditional fee-for-service model is giving way to value-based models that tie reimbursement to quality of care and patient outcomes. This transformation in reimbursement is […]
Accountable Care Organizations, Billing Operations, Bundled Payments, Capitation, Fee-for-Service, fee-for-service model, P4P, P4P Model, Pay-for-Performance, reimbursement, Reimbursement Disruption, Value Based System, Value-Based Models, Value-based Reimbursement
Oncology billing involves the use of many complex CPT codes to accurately report services provided to cancer patients. Choosing the right codes is critical for ensuring proper reimbursement and compliance with billing guidelines. We provide an overview of the most common CPT codes used in oncology billing and coding. Evaluation and Management (E/M) Codes E/M […]
biopsies/procedures, cancer, Cancer Billing, Chemo Billing, chemo drugs, chemotherapy administration, Chemotherapy Administration Codes, Diagnostic Injections, E/M services, HCPCS, lab/pathology, medical oncology services, nuclear medicine, Nuclear Medicine Billing, Oncology billing and coding, pain management, Prophylactic, Radiation Oncology Services, radiation therapy, Therapeutic, therapeutic injections, treatment complications
The healthcare industry is rapidly evolving, driven by advances in technology, changes in regulations, and shifts in consumer behavior. For medical billing professionals, these changes bring both opportunities and challenges. Staying up-to-date on the latest trends is key to remaining competitive and providing the best possible service to healthcare providers. We’ll explore the top 10 […]
artificial intelligence, Big Data, Billing RPA, Changing Regulations, Cybersecurity, healthcare, Medical Analytics, Medical Billing, Medical Billing Analytics, Medical Billing Trends, Patient Consumerism, Payment Models, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA, telehealth, Virtual Care
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 optimizationAt 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
Medical providers face numerous challenges when it comes to getting paid for their services in a timely manner. Between complicated insurance requirements, claim denials, and administrative burdens, it can often take weeks or even months for providers to receive payment. This cash flow bottleneck can put significant financial strain on medical practices and hospitals. One […]
healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, medical billing strategy, Outsource Medical billing, outsourced billing, outsourced medical billing, Revenue Cycle Management, revenue cycle optimization
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