Charge capture matters because, as a healthcare provider, you know how important it is to get paid accurately and on time for the services you provide. However, 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 […]
Continuous Monitoring, Missed Charges, Revenue Cycle Management, Revenue Leakage
Choosing the right clearinghouse services decides how many of your claims reach payers clean on the first pass and how quickly rejections come back for correction. A clearinghouse sits between your billing system and every payer you bill, translating claims into the formats payers accept, catching errors before submission, and routing remittances and status updates […]
CAQH CORE Certification, Data Translation, Data Validation, EHNAC Accreditation, Value-Added Services
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. Medicare Coverage for Toxicology […]
Advanced Beneficiary Notice, Medicare Coverage for Toxicology Tests, Medicare Reimbursement, Toxicology Billing
CPT codes for remote patient monitoring (RPM) billing are one of the first things a healthcare provider needs to know when getting into RPM. 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 pandemic when more people wanted […]
Remote Diagnostics, Remote Patient Monitoring Billing, 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 a feel for 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 Startup, RCM Startup, Revenue Cycle Management, Start a Medical Billing Company
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 Systemic Reform, Billing Transparency, No Surprises Act, Revenue Cycle Management
In the healthcare system, one aspect that has undergone a remarkable transformation is the way medical bills are processed and submitted. Gone are the days when mountains of paper claims and endless filing cabinets were the norm. Instead, healthcare providers have embraced the power of electronic medical billing systems, revolutionizing the revenue cycle management process and […]
Better Patient Experience, Billing Automation, Digitization of Medical Billing, Revenue Cycle Management, RPA
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 burden of payer regulations, coding details, 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 Software, Billing Workflow, Interoperability Standards, NLP, RCM
The field of genetics has experienced remarkable advancements in recent years, revolutionizing our knowledge 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 coverage and reimbursement challenges. As genetic testing becomes […]
DNA Testing, Genetic Testing Billing, Genetic Testing Reimbursement, Genetics, Genomics, Genomics Billing
Medical billing challenges make the billing process a daunting task for healthcare providers, and each one has a solution. From keeping up with ever-changing regulations and coding updates to managing denials and claim rejections, medical billers face numerous challenges that can significantly impact revenue cycle management and the financial health of a practice. We cover […]
A/R Management, Benefits Verification, Coding Accuracy, Denial Management, Patient Eligibility, Payer Contracting
CPT codes for telestroke and teleneurology billing depend on how care is delivered by telehealth. Telestroke and teleneurology refer to the use of telehealth to provide acute stroke care and neurological care from a distance. This allows neurologists and stroke specialists to evaluate and manage patients in hospitals or clinics that may not have specialty care […]
Telehealth Billing, Telemedicine Billing, Teleneurology Billing, Teleneurology CPT Codes, Telestroke Billing, Telestroke CPT CodesImproper bundling in medical billing occurs when services that should be billed under a single CPT code are instead billed as separate component codes to generate higher reimbursement, a practice CMS classifies as unbundling. The inverse error, combining services that should be billed separately under a single code, results in underpayment and lost revenue. Both […]
Component Codes, Comprehensive Codes, Improper Bundling, Modifier Codes, Unbundling
Fixing common medical billing errors improves revenue, reduces denials, and supports compliance for healthcare providers. Frequent billing mistakes can hurt your medical practice’s bottom line. Discover the most common medical billing errors, their financial impact, and proven steps to prevent them. This extensive billing guide for providers, clinics, and medical billers will help fix errors […]
Diagnosis Code Errors, Incorrect Modifiers, Medical Billing Errors, Missing Pre-Authorizations, Procedure Code Mistakes
Medical billing automation uses software to handle the repetitive parts of the revenue cycle, such as eligibility checks, claim scrubbing, claim status follow-up, and payment posting, so billers spend their time on the claims that need judgment. Most practices already automate a little through their practice management system. The difference between a little and a […]
Artificial Intelligence, Billing Automation, Revenue Cycle Management, Robotic Process Automation
Electronic health records (EHRs) have become an indispensable part of healthcare operations, which is why connecting an EHR to a clearinghouse matters. 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 […]
Clearinghouse, EMR, HL7, Interoperability, Revenue Cycle Management
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 […]
Medical Billing Staff, Outsourced Billing, RCM, Revenue Cycle Optimization, Robotic Process Automation
The CPT codes used in pharmacogenetic (PGx) testing billing are mostly single-gene molecular pathology codes, one per gene, with a growing set of lab-specific PLA codes for branded panels. Which ones a lab can bill, and which ones a payer will actually pay, depends on the genes that were clinically needed for the drug decision […]
CPT Codes, PGx Billing, PGx CPT Coding, Pharmacogenetics Billing
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 Software, HL7, Medical Billing, Robotic Process Automation
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 ICD-10 in […]
Clinical Documentation, ICD-10 Optimization, ICD-10 Update, Medical Coder Training
Accuracy in both medical coding and billing processes is imperative for maximizing appropriate reimbursement, maintaining regulatory compliance, and optimizing revenue cycle performance. Even minor errors can have major consequences in delayed or reduced payments, denied claims, and compliance risks. We cover the most common coding and billing mistakes along with best practices to identify where […]
Billing Errors, Coding Errors, Documentation