Billing & Credentialing Cranberry Twp. (Pittsburgh)
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Call: (412) 219-4789 | Fax: (866) 422-9277
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  • Reimbursement Models

Reimbursement Models

Tough Questions Providers May Ask Billers

December 1, 2024 / admin / Articles, Billing, Claim Denial Rate, Claim Denials, Compliance, EHR, EMR, Interoperability, Medical Billers, Medical Billing, Medical Billing Questions, Modifiers, Reimbursement, Reimbursement Models, Reimbursement Optimization
Latina Female Medical Provider Owner

The relationship between medical providers and their billing teams has become increasingly crucial to practice success. As reimbursement models grow more complicated and regulatory requirements more stringent, providers often find themselves grappling with challenging questions about their revenue cycle management. We’ll address the most demanding and complex questions that medical providers frequently ask their billing […]

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billing, Claim Denial Rate, Claim Denials, compliance, EHR, EMR, Interoperability, Medical Billers, Medical Billing, medical billing questions, Modifiers, reimbursement, Reimbursement Models, Reimbursement Optimization

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

Navigating Fee Schedules and Reimbursement Rates

May 12, 2024 / admin / Articles, Fee Schedule, Fee Schedules and Reimbursement Rates, Optimizing Reimbursements, Reimbursement, Reimbursement Model Shift, Reimbursement Models, Reimbursement Optimization, Reimbursement Rates, Reimbursement Regulations
Navigating Fee Schedules and Reimbursement Rates

Few topics get finance teams and medical billing professionals quite as fired up as fee schedules and reimbursement rates. It’s the core of how healthcare providers generate revenue and keep operations humming. At the same time, it’s an arena loaded with complexity, regulatory scrutiny, and often mind-numbing minutiae. If you’re reading this, you’re probably intimately […]

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Fee Schedule, Fee Schedules and Reimbursement Rates, Optimizing Reimbursements, reimbursement, Reimbursement Model Shift, Reimbursement Models, Reimbursement Optimization, reimbursement rates, Reimbursement Regulations

How to Renegotiate Your Payer Contracts

April 15, 2024 / admin / Articles, Data Analytics, Payer Contract, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer Enrollment, Payer Negotiation, Reimbursement, Reimbursement Models, Reimbursement Rates, Renegotiate Payer Contracts
Renegotiating Payer Contracts

So, it’s that time again. Your payer contracts are up for renewal and you need to renegotiate. Maybe you’re feeling like the reimbursement rates they’re offering are way too low. Or the administrative burdens and preauthorization requirements have gotten out of hand. Whatever the reason, you know you need to go back to the negotiating […]

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Payer Contract, Payer Contract Re-Negotiation, Payer Contracting, Payer Contracts, Payer enrollment, Payer Negotiation, reimbursement, Reimbursement Models, reimbursement rates, Renegotiate Payer Contracts

The Challenges and Opportunities of Digital Therapeutics (DTx) Reimbursement

February 19, 2024 / admin / Articles, Digital Health Center of Excellence, DTx, DTx Billing, DTx Reimbursement, Integration, Real-World Evidence, Reimbursement, Reimbursement Disruption, Reimbursement Models, Revenue Cycle, Revenue Cycle Management, RWE
Digital Therapeutics Reimbursement

The healthcare industry is undergoing a digital transformation, with software-based therapeutic interventions known as digital therapeutics emerging as disruptive new modalities to prevent, manage, and treat a growing range of medical conditions. Digital Therapeutics Breakdown Digital therapeutics deliver evidence-based treatments directly to patients through smart devices and applications. These data-driven tools provide personalized interventions, feedback, […]

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Digital Health Center of Excellence, DTx, DTx Billing, DTx Reimbursement, healthcare, Integration, Interoperability, Interoperability and Integration, Medical, Medical Billing, Optimize Reimbursement, Real-World Evidence, reimbursement, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, RWE

The Reimbursement Model Shift in Medical Billing

January 29, 2024 / admin / Accountable Care Organizations, Articles, Billing, Billing Operations, Bundled Payments, Capitation, Fee-for-Service, Fee-for-service Model, Medical Billing, P4P, P4P Model, Pay-for-Performance, Reimbursement Disruption, Reimbursement Models, Value-based Care, Value-Based Models, Value-based Reimbursement
Medical Billing Company Employees

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 […]

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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

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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

  • White Male Payer Contracting Specialist

    How to Properly Negotiate Payer Contracts

  • Cardiovascular Diseases CPT Codes

    Commonly Used Cardiovascular Disease CPT Codes

  • Medical CPT Codes

    Common Diseases and Their CPT Codes

  • Laboratory Billing

    Which CPT Codes are Used in Laboratory Billing?

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