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 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
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
Cases of a new COVID-19 variant, temporarily designated JN.1, are rising rapidly nationwide. According to data from the U.S. Centers for Disease Control and Prevention, JN.1 now accounts for 44% of all COVID-19 infections in the country. That represents more than double its share compared to just a week prior, highlighting the dramatic growth rate […]
COVID billing, COVID Testing, COVID testing billing, COVID-19, COVID-19 testing, Healthcare, Healthcare Billing, JN.1, Medical, Medical Billing, Outsourced Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
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
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, RPACPT 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 role […]
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, VKORC1
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. We […]
(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 IntegrationMedical 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 BillingFor 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 […]
AI, Healthcare, Healthcare Billing, Intelligent automation, Manual Billing Workflow, Medical, Medical Billing, Medical Billing Automation, Medical Billing Robotic Process Automation, Medical Billing Service, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation, Robotic Process Automation Billing, RPA
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 […]
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
The MGMA benchmark for accounts receivable days in a well-run medical practice is 30–35 days. If your practice is sitting above 50, you’re leaving real revenue on the table, and the longer those balances age, the harder they are to collect. In our 30+ years managing revenue cycles at Medwave, we’ve seen practices recover six […]
Accounts Receivable Days, AR Recovery, Clean Claim Rate, Denial Management, Medical Billing, Patient Collections, Revenue Cycle Management, Revenue Cycle Optimization
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? We explore key factors influencing medical billing and coding salaries, average pay ranges, top […]
Billing, Healthcare, Healthcare Billing, Medical, Medical Biller, Medical Billing, Medical Billing and Coding Salaries, Medical Billing Salary, Medical Coder, Medical Coding Salary