Billing & Credentialing Cranberry Twp. (Pittsburgh)
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Call: (412) 219-4789 | Fax: (866) 422-9277
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    • Behavioral Health
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    • Pharmacogenetic (PGx) Testing
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    • Oncology
    • Pathology
    • OBGYN
    • Biologics and Specialty Drugs
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    • Remote Therapeutic Monitoring
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RCM

How to Set Clear Goals for Medical Billing That Keep Your Practice Profitable

November 2, 2024 / admin / Articles, Billing, Billing Goals, Clean Claim Rate, Medical Billing, Medical Billing Goals, RCM, RCM Optimization, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
Crazy Medical Coder Biller

Let’s face it – medical billing isn’t exactly the most exciting part of running a healthcare practice. But here’s the thing: those numbers directly impact whether your practice thrives or struggles. Having worked with countless medical practices over the years, I’ve seen firsthand how setting clear, strategic billing goals can transform a practice’s financial health. […]

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billing, Billing Goals, Clean Claim Rate, Medical Billing, Medical Billing Goals, rcm, RCM Optimization, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization

Where Should Providers Focus their Billing Resources?

October 7, 2024 / admin / Articles, Medical Billing, Medical Billing AI, Patient Experience, Patient Registration, Patient Responsibility, Practice Management, Prior Authorization, RCM, Revenue Cycle Automation, Robotic Process Automation, RPA
Medical Billing Resources

Effective medical billing is crucial for the financial health and sustainability of healthcare providers. With limited resources and increasing administrative burden, providers must strategically allocate their billing resources to maximize revenue while maintaining compliance and patient satisfaction. This analysis explores key areas where healthcare providers should focus their medical billing efforts to optimize outcomes and […]

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Medical Billing, Medical Billing AI, Medical Billing Tips, Medical Billing Trends, Patient Experience, Patient registration, Patient Responsibility, Practice Management, prior authorization, rcm, Revenue Cycle Automation, Revenue Cycle Management, Robotic Process Automation, RPA

Maximizing Healthcare Provider Reimbursement

August 9, 2024 / admin / Articles, Charge Capture, Data Analytics, Denial Management, Fee Schedule, Medical Coding, Outsourced Billing, Payer Contract, Payer Contracting, RCM, Reimbursement, Reimbursement Models, Reimbursement Optimization, Value-based Care
Medical Reimbursement

Achieving maximum reimbursement is crucial for healthcare providers to maintain financial stability and continue delivering high-quality patient care. We explore key strategies and best practices that healthcare providers in the United States can implement to optimize their reimbursement processes and maximize revenue. Understanding the Reimbursement Landscape Before diving into specific strategies, it’s essential to understand […]

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Charge Capture, Data Analytics, denial management, Fee Schedule, medical coding, outsourced billing, Payer Contract, Payer Contracting, rcm, reimbursement, Reimbursement Models, Reimbursement Optimization, Value Based Care

How to Optimize Billing Reimbursement

August 7, 2024 / admin / Articles, Automation, Charge Capture, Denial Management, Denial Management Process, Patient Collections, Payer Contracting, Payer Contracts, Payer Enrollment, Payor Contract, Prior Authorization, Prior Authorization Process, Prior Authorizations, Proper Coding, RCM, Revenue Cycle, Value-Based Models
Navigating Fee Schedules and Reimbursement Rates

Effective billing practices are crucial for healthcare providers, medical offices, and businesses across various industries to maintain financial stability and ensure proper compensation for services rendered. Optimizing reimbursement in billing involves implementing strategic processes, leveraging technology, and staying compliant with industry regulations. We discuss key strategies and best practices to maximize reimbursement rates and streamline […]

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Automation, Charge Capture, denial management, Denial Management Process, Patient Collections, Payer Contracting, Payer Contracts, Payer enrollment, Payor Contract, prior authorization, Prior Authorization Process, Prior Authorizations, Proper Coding, rcm, Revenue Cycle, Value-Based Models

5 Ways to Boost Revenue Cycle Management

June 4, 2024 / admin / Articles, RCM, RCM Automation, RCM Challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue Cycle, Revenue Cycle Automation, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Optimization
RCM Optimization

If you’re running a healthcare organization, you know how crucial it is to have an efficient revenue cycle management (RCM) process. After all, it’s the backbone of your financial operations, ensuring that you get paid for the services you provide. But let’s be real, managing the revenue cycle can be a complex and daunting task, […]

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rcm, RCM Automation, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue Cycle, Revenue Cycle Automation, Revenue Cycle Management, revenue cycle optimization, revenue optimization

Medical Provider Fee Schedules: How Do They Compare and What’s Next?

May 24, 2024 / admin / Articles, Fee Schedule Comparison, Fee Schedule Landscape, Future of Fee Schedules, Healthcare Fee Schedules, Healthcare Outcomes, Healthcare Revenue, Medical Provider Fee Schedule, RCM, RCM Optimization
Medical Provider Fee Schedules

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 […]

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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

Revenue Cycle Metrics for Healthcare Financial Success

May 3, 2024 / admin / Articles, RCM, RCM Challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Cycle Process, Revenue Optimization
RCM Optimization

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 […]

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rcm, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Cycle Process, revenue optimization

The Importance of Negotiating Payer Contracts

April 19, 2024 / admin / Articles, Payer Contract, Payer Contract Negotiation, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer Enrollment, Payer Negotiation, Payer Regulations, RCM, Revenue Cycle Management, Revenue Cycle Process
Payer Contracting White Female

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 […]

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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

Claim Denial Kryptonite: Specialty-Specific Strategies to Supercharge Your Revenue Cycle

March 26, 2024 / admin / Articles, Claim Denials, Coding, Coding and Billing, Denial Kryptonite, Denial Management, Denied Claims, Denied Medical Claims, Diagnosticians, E&M code, Interventionists, Lex Luthor, Medical Billing, Proceduralists, RCM, Revenue Cycle, Revenue Cycle Management, Superman, Therapists
Denial Kryptonite

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 […]

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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), Therapists

Understanding the Latest Healthcare Regulatory Changes Impacting RCM

March 8, 2024 / admin / Affordable Care Act, Articles, Coding and Documentation, Cybersecurity, Data Privacy, Health Equity, Interoperability, Non-Discrimination Regulations, Price Transparency, RCM, Regulatory Changes, Regulatory Compliance, Regulatory Requirements, Revenue Cycle Management, Telehealth, Value Based Care, Virtual Care Regulations
RCM Product Managers

The healthcare industry is dynamic, and staying up-to-date with the latest regulatory changes is crucial for efficient Revenue Cycle Management (RCM). RCM encompasses the processes involved in tracking and collecting patient service revenue, from the initial registration and appointment scheduling to the final payment of balances. Failure to comply with regulatory requirements can result in […]

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Affordable Care Act, Coding and Documentation, Cybersecurity, Data Privacy, Environmental Sustainability, Health Equity, HIPAA, Interoperability, No Surprises Act, Non-Discrimination Regulations, Patient Access, Price Transparency, Regulatory Changes, Regulatory Compliance, Regulatory Requirements, telehealth, Value Based Care, Virtual Care Regulations

Data Analytics for RCM: Turning Numbers into Actionable Insight

March 7, 2024 / admin / Articles, Cloud Computing, Data Analytics, Data Democratization, Internet of Things, IoT, Prescriptive Analytics, RCM, RCM Case Studies, RCM Data Analytics, RCM Optimization, Self-Service Analytics
RCM Data Analytics

Healthcare organizations are swimming in an ocean of information. From electronic health records to claims data, patient surveys to online reviews, the sheer volume of data can be overwhelming. However, this data holds the key to unlocking insights that can vastly improve revenue cycle management (RCM) processes and drive better financial outcomes. When harnessing the […]

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artificial intelligence, Big Data, Cloud Computing, Data Analytics, Data Democratization, Internet of Things, IoT, Machine Learning, Predictive Analytics, Prescriptive Analytics, RCM Data Analytics, Self-Service Analytics

How Leading Providers Optimized Their RCM Performance

March 6, 2024 / admin / Articles, Case Studies, Denial Analytics, Denial Management, Denial Trends, RCM, RCM Case Studies, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Cycle Process, Revenue Integrity
RCM Case Studies

The healthcare revenue cycle management (RCM) process is a complex and critical set of activities that encompasses everything from patient registration and appointment scheduling to final payment collection. With rising costs, shrinking reimbursements, and increasing regulatory burdens, optimizing RCM performance has become essential for provider organizations to ensure financial viability and sustainability. We cover four […]

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billing, Case Studies, Charge Capture, Denial Analytics, denial management, Denial Trends, healthcare, Medical, Medical Billing, rcm, RCM Case Studies, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Cycle Process, Revenue Integrity

10 Key Medical Billing Challenges and Solutions

March 5, 2024 / admin / A/R, A/R Recovery, Articles, COB, Coding Accuracy, Healthcare KPIs, Healthcare Outcomes, HIPAA, HIPAA Compliance, Patient Eligibility, Patient Insurance Eligibility, Payer Contracting, RCM, RCM Challenges, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Process, Timely Claim Submission
White Female Medical Billing Outsourced

The medical billing process is a complex and often daunting task for healthcare providers. 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 10 key medical billing challenges […]

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A/R, A/R Management, Benefits Verification, COB, Coding Accuracy, denial management, HIPAA, HIPAA Compliance, Patient Eligibility, Payer Contracting, Revenue Cycle Management, Revenue Cycle Process, revenue optimization, Timely Claim Submission

Exploring the Integration of ChatGPT in Revenue Cycle Management

February 24, 2024 / admin / AI-driven RCM, Articles, Billing, ChatGPT, ChatGPT in Healthcare, ChatGPT in RCM, ChatGPT in Reimbursement, Healthcare KPIs, Healthcare Outcomes, Healthcare Revenue, Medical Billing, OpenAI, RCM, RCM Challenges, Reimbursement, Revenue Cycle, Revenue Cycle Management
ChatGPT Revenue Cycle Management

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 […]

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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

Manual Medical Billing is Dead, RPA is the Answer

February 11, 2024 / admin / Articles, Automated Billing, Automation, Billing Analytics, Billing Automation, Manual Billing, RCM, Reimbursement, Revenue Cycle, Revenue Cycle Management, Robotic Process Automation, RPA, RPA Adoption, RPA HL7
robotic-process-automation-RPA-example-code

Medical billing has long relied on manual data entry and paperwork to process claims. But this antiquated approach is no longer sustainable in today’s digital healthcare environment. The future of medical billing lies with robotic process automation (RPA). RPA automates repetitive data entry and workflow tasks, increasing efficiency, reducing human error, and allowing medical billers […]

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Billing Analytics, Billing Automation, healthcare, Healthcare Billing, Manual Billing, Medical, Medical Billing, Medical Billing Robotic Process Automation, rcm, Revenue Cycle, Revenue Cycle Management, Robotic Process Automation, RPA, RPA Adoption

Medical Billing versus the Sports World: An Unlikely Comparison

January 21, 2024 / admin / Articles, Artificial Intelligence, Billing, Billing Revenue, Billing Services, Claim Billing, Data Management, Healthcare, Healthcare Billing, Medical Billing, RCM, Revenue Cycle, Revenue Cycle Management, Sports
Medical Billing versus Sports

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 […]

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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

Relieving Medical Billing Frustrations: The Benefits of Outsourcing to Qualified Professionals

December 28, 2023 / admin / Articles, Billing, Billing AI, Billing Automation, Billing RPA, Claim Billing, Claim Denials, Claims Management, Denial Management, Denied Claims, Healthcare, Healthcare Billing, Medical Billing, Medical Billing AI, RCM, Revenue Cycle, Revenue Cycle Management
Outsourcing Medical Billing

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 […]

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billing, healthcare, Healthcare Billing, Medical, Medical Billing, outsourced billing, outsourced medical billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA

The Secret Sauce: Essential Ingredients for Optimized Medical Billing Outcomes

December 27, 2023 / admin / Articles, Biling Codes, Billing, Billing AI, Billing Automation, Billing Best Practice, Healthcare Billing, HIPAA, Medical Billing, Medical Billing Ingredients, RCM, Reimbursement, Revenue Cycle Management, Robotic Process Automation, RPA, Secret Sauce
Secret Sauce of Medical Billing

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 […]

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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

Boosting Revenue Integrity: 7 Keys to Unlocking Efficient, Effective Medical Billing

December 18, 2023 / admin / Articles, Billing, Billing Revenue, Claims Management, Denial Management, Healthcare, Healthcare Billing, KPI, Medical Billing, Medical Billing KPIs, RCM, RCM Challenges, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management (RCM), Revenue Cycle Optimization, Revenue Integrity
Medical Billing White Guy

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 […]

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Payer Enrollment vs. Credentialing: Understanding The Differences

November 13, 2023 / admin / Articles, Enrollment, Payer Contract, Payer Contracting, Payer Enrollment, Payer Negotiation, RCM, RCM Challenges, Revenue Cycle Management, Revenue Cycle Management (RCM), Revenue Cycle Management Challenges
Medical Billing Credentialing Team

What is Payer Enrollment? Payer enrollment is a process by which healthcare providers enroll with insurance companies to receive payment for services rendered. This process involves completing an application, providing necessary documentation, and meeting specific requirements set by the payer. The payer may review the application and documentation to determine if the healthcare provider meets […]

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Credentialing, credentialing process, enrollment, healthcare, Medical, medical credentialing, Payer Contracting, Payer enrollment

Getting Paid Faster: Strategies to Improve Cash Flow Cycles

October 16, 2023 / admin / Articles, Billing, Cash Flow Cycles, RCM, RCM Challenges, Reimbursement, Reimbursement Rates, Reimbursement Regulations, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management (RCM), Revenue Cycle Management Challenges
Billing Cash Flow Cycles

For any medical practice, timely insurance reimbursement is essential for financial viability and supporting smooth practice operations. However, elongated claim payment cycles strain cash flow and necessitate borrowing to cover costs in the interim. Below, we explore techniques to accelerate payer payments and optimize the speed of the medical revenue cycle. Diagnosing Causes of Lagging […]

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Cash Flow Cycles, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, medical billing strategy, rcm, reimbursement, reimbursement rates, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization

Growing Risk of Claim Denials: How to Protect Your Practice

October 6, 2023 / admin / Articles, Billing, Billing Denied Claims, Claim Denials, Claim Rejection, Claim Status, Claim Status Updates, Denial Codes, Denial Management, Denial Prevention Strategy, Denial Trends, Denied Claims, Denied Medical Claims, RCM, RCM Challenges, Revenue, Revenue Cycle Management, Revenue Integrity, Revenue Leakage
Medical Claim Denied

For medical practices, claim denials have always been a fact of life when dealing with health insurers. However, trends show claim denial rates growing year over year, driven by increased utilization management efforts by payers. Denials directly impact practice revenues and the time/costs tied to appealing denials. Below, we take a gander at the factors […]

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Claim Denials, Denial Codes, Denial Prevention Strategy, Denial Trends, Denials, denied medical claims, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Revenue Cycle Management, revenue cycle optimization

Understanding the Difference Between Medical Billing and Revenue Cycle Management

May 1, 2023 / admin / Articles, Billing AI, CPT, CPT Code, CPT Codes, Healthcare, Healthcare Billing, Healthcare Revenue, ICD-10, Medical, Medical Billing, RCM, Revenue, Revenue Cycle Management, Revenue Cycle Management (RCM)
White Female Medical Billing Outsourced

In the complex world of healthcare, managing the business side of things can often be overwhelming, especially for those new to the field. One common question that arises is the distinction between medical billing and revenue cycle management (RCM). Although the term “medical billing” has been around for a long time, RCM encompasses the entire […]

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CPT, healthcare, Healthcare Billing, ICD, Medical, Medical Billing, Medical Billing Service, medical billing software, medical credentialing, rcm, Revenue Cycle, Revenue Cycle Management

What to Know Before Starting Your Own Medical Billing Company?

March 9, 2023 / admin / Articles, Billing, Billing Services, Healthcare, Healthcare Billing, Medical Billing, Medical Billing Careers, Medical Billing Companies, Medical Billing Jobs, Medical Billing Services, Medical Coding, RCM, Revenue Cycle Management
Medical Billing Outsourced

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services provided by healthcare providers. With the increasing complexity of medical billing and coding procedures, there has been a surge in demand for medical billing companies. Many entrepreneurs are now considering starting their […]

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Medical, Medical Billing, Medical Billing Service, Outsource Billing, Outsource Medical billing, outsourced billing, outsourced medical billing, rcm, Revenue Cycle Management

Maximizing Reimbursement: 10 Tips for Successful Medical Billing

March 3, 2023 / admin / Accounts Receivable, Articles, Billing, Billing Revenue, Healthcare, Healthcare Billing, Healthcare Revenue, Medical, Medical Billing, Medical Billing and Coding, Medical Billing Tips, Medical Regulations, Outsource Medical Billing, RCM, Revenue Cycle Management, Revenue Cycle Management (RCM)
Medical Owner White Businessman

Medical billing is a critical aspect of the healthcare industry, as it ensures that healthcare providers are paid for the services they provide to patients. However, medical billing can be a intricate process, and many healthcare providers struggle to maximize reimbursement for their services. To maximize reimbursement, healthcare providers should focus on accurate medical coding, […]

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Healthcare Billing, Medical Billing, Medical Billing Service, Outsource Billing, Outsource Medical billing, outsourced billing, outsourced medical billing, rcm, Revenue Cycle Management
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Practices Served

  • Behavioral Health
  • Genetic Testing
  • Pharmacogenetic (PGx) Testing
  • Toxicology
  • COVID-19 Testing
  • Allergy Testing
  • Skilled Nursing Facilities
  • Urgent Care
  • Oncology
  • Pathology
  • OBGYN
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Speech Therapy
  • Substance Abuse
  • DME
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy

Practices Served

  • Behavioral Health
  • Genetic Testing
  • Pharmacogenetic (PGx) Testing
  • Toxicology
  • COVID-19 Testing
  • Allergy Testing
  • Skilled Nursing Facilities
  • Urgent Care
  • Oncology
  • Pathology
  • OBGYN
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Speech Therapy
  • Substance Abuse
  • DME
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy

Recent Posts

  • Laboratory Billing

    Which CPT Codes are Used in Laboratory Billing?

  • Medical Credentialing Staff at a Hospital

    25 Stats Medical Credentialers Must Know

  • Older Female Doctor in need of Credentialing

    Credentialing Problems? We Can Fix Them!

  • Medical Credentialing State-by-State

    Multi-State Licensing in Provider Credentialing

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