A management services organization (MSO) takes over the business side of a private practice, from payroll and billing follow-up to HR and vendor contracts, so physicians can spend their hours on patients instead of spreadsheets. The pitch is easy to like. Whether it works for your practice comes down to the management services agreement behind […]
Credentialing, Healthcare Attorneys, Medical Billing, MSA, MSOs, Payer Contracting, Private Practice
An approved authorization can still end in a denied claim flagged for an authorization mismatch. The authorization number is right there in the system. It says approved. Yet, the claim comes back denied anyway, flagged for an authorization mismatch. If that sequence sounds familiar, you are not imagining things and you are not alone. It […]
Claim Denials, Credentialing, Denial Management, Medical Billing, Prior Authorization, Pyer Contracting, Revenue Cycle Management
If you want a single number that tells you how well your practice is actually getting paid, the net collection rate is it. It cuts through the noise of gross charges and list prices and gets straight to the question that matters most. Out of the money you were contractually entitled to collect, how much […]
Days in Accounts Receivable, Denial Management, Gross Collection Rate, Medical Billing, Revenue Cycle Management
The top 12 reasons claims get denied explain why getting paid for the healthcare services you provide is harder than it should be. You deliver quality care, submit your claims, and receive payment. Yet for many healthcare providers, the reality looks quite different. Claims get denied, payments are delayed, and the administrative burden grows heavier […]
Denial Management, Denied Claims, Medical Billing, RCM
General surgery practices rely on accurate CPT (Current Procedural Terminology) coding to ensure proper reimbursement and maintain compliance with healthcare billing standards. Knowledge of the most commonly used codes in general surgery billing is essential for medical coders, practice administrators, and healthcare providers working in this specialty. CPT Code Categories in General Surgery The CPT […]
General Surgery Billing, General Surgery CPT Codes, Medical Billing
Setting clear goals for medical billing is rarely the most exciting part of running a healthcare practice. 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. Why Traditional Billing Goals […]
Billing Goals, Medical Billing, Revenue Cycle Management, SMART goals
ICD-11 puts medical billing on the cusp of a significant transformation with the introduction of the International Classification of Diseases, 11th Revision (ICD-11). This sweeping update to the global standard for health data, clinical documentation, and statistical aggregation promises to revolutionize medical billing practices. The key features of ICD-11 and its potential impacts on the […]
ICD Codes, ICD-10 to ICD-11, Medical Billing, Revenue Cycle Management
In medical billing and coding, knowing Common Procedural Terminology (CPT) codes is essential. These codes act as a universal language, supporting smooth communication between healthcare providers and insurance entities. Let’s look at CPT codes, exploring their significance and shedding light on the most commonly used ones. Decoding CPT Codes: A Brief Overview Before we start […]
CPT Codes, Medical Billing, Medical Reimbursement, Revenue Cycle Management
CPT codes for speech therapy billing cover services that are critical for evaluating and treating communication disorders, swallowing difficulties, and cognitive-linguistic impairments. However, selecting the proper CPT codes for speech therapy can be difficult given the many types of assessments, modalities, and interventions provided. We examine the most frequently used Current Procedural Terminology (CPT) codes […]
CPT Codes, Evaluation Codes, Medical Billing, Speech Billing, Speech Therapy BillingCPT codes for nursing facility billing cover post-acute rehabilitation and custodial care. Nursing facilities fulfill a critical role in the post-acute care continuum by providing rehabilitation and custodial care services to patients not yet ready to transition home after hospitalization. The range of skilled nursing services offered enables recovery and stabilization for populations such as […]
CPT Codes, Medical Billing, Nursing Facility Evaluation, Skilled Nursing Billing, Skilled Nursing FacilitiesA medical claim is the formal request a healthcare provider submits to an insurance payer asking for reimbursement for services delivered to a covered patient. Every claim contains standardized codes identifying the diagnosis, the procedure performed, and the provider who delivered care, along with patient demographics, insurance information, and the amount billed. The payer reviews […]
Claim Denials, Claim Rejection, Denial Management, Medical Billing, Medical Claims
Telehealth billing has become more complicated since the COVID-19 pandemic triggered an explosion in telehealth utilization across healthcare. While telehealth billing processes matured during the public health emergency, new challenges 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 […]
Medical Billing, RCM, Remote Patient Monitoring, Telehealth, Telemedicine
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
CPT codes for DME billing apply to Durable Medical Equipment (DME), which refers to medical equipment and supplies that are intended for long-term use by individuals with medical conditions or disabilities. Some common types of DME include wheelchairs, walkers, crutches, canes, hospital beds, patient lifts, oxygen equipment, nebulizers, and continuous positive airway pressure (CPAP) machines. […]
DME, DME Billing Service, DME CPT Codes, Medical Billing
Behavioral health HCPCS codes such as H0004, H0031, H0036 and H2019 are how most state Medicaid programs pay for community mental health and substance use services, while CPT codes such as 90834 and 90837 cover psychotherapy billed to Medicare and commercial plans. Many practices bill both sets in the same week, and the two follow […]
Behavioral Health Billing, Behavioral Health CPT Codes, Medical Billing
“Revenue leakage” describes circumstances wherein a healthcare provider has supplied care to a patient but doesn’t collect payment. In general, it happens when accounts receivable (AR) continue to be unpaid for too long and are inadvertently overlooked. The longer an account receivable remains outstanding, the less likely healthcare providers are to retrieve payment, even in […]
AR Cycles, Medical Billing, Patient Centricity, RCM, Revenue Leakage
Patient Collections Strategies FAQ 7 Strategies to Maximize Patient Collections Any medical provider knows how difficult it is to get paid for their services. 73 percent of healthcare providers assert that it takes 30+ days to recover their payment fully. Various issues like complicated billing procedures, changing payer fee schedules, employee attrition, government directives, lack […]
Basics of Medical Billing, Collection Process, Medical Billing, Medical Billing Strategies, Patient Collections
Prior authorization is a requirement no patient or healthcare provider wants to hear about when they are ready to proceed with a doctor-approved procedure. “This procedure will require prior authorization.” However, it’s one of the utilization management tools that insurance companies have encouraged to decide if specific prescribed procedures, services and medications are medically required […]
Billing and Coding, Medical Billing, Prior Authorization Process, Reimbursement, Revenue Cycle Management