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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Posts tagged "Medical Billing"
What to Expect When Outsourcing Medical Billing
If you’re a healthcare provider, dealing with medical billing is probably one of your least favorite parts of the job. It’s tedious, complicated, and takes you away from your real passion – caring for patients. That’s why many practices choose to outsource their medical billing to third-party companies that specialize in it. But what does […]
billing, Billing AI, Billing Analytics, Billing KPIs, billing revenue, Billing RPA, Medical Billing, Medical Billing AI, outsourced billing, outsourced medical billing, Outsourcing, Revenue Cycle ManagementMastering Charge Capture: A Roadmap for Healthcare Providers
If you’re a healthcare provider, you know how important it is to get paid accurately and on time for the services you provide. But 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 the process of […]
billing, Charge Capture, Charge Capture Challenges, Charge Capture Strategy, Denials, EHR, EMR, Medical Billing, Missed Charges, Optimized Charge Capture, Revenue Cycle Management, Revenue LeakageMedicare Reimbursement: Understanding the Labyrinth
If you’re a healthcare provider or facility dealing with Medicare, one thing is certain – getting properly reimbursed is a maze filled with complex rules, convoluted paperwork, and often, sheer frustration. Medicare reimbursement is the lifeblood that keeps many healthcare operations afloat, but navigating its serpentine pathways can feel like a daily battle. Buckle up […]
APC, APCs, CMS, Geographical Practice Cost Index, healthcare, Healthcare Billing, Inpatient Prospective Payment System, IPPS, Medical, Medical Billing, medicare, medicare billing, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare Physician Fee Schedule, Medicare Reimbursement, Medicare Severity Diagnosis Related Groups, MIPS, MS-DRG, OPPS, Prospective Payment Systems, Revenue Cycle, Revenue Cycle ManagementWhich CPT Codes are Used in Remote Patient Monitoring Billing?
If you’re a healthcare provider looking to get into remote patient monitoring (RPM), one of the first things you need to understand is how to bill for these services. 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 […]
99091, 99453, 99454, 99457, 99473, 99474, billing, CPT codes, Healthcare Billing, Medical Billing, rcm, Remote Patient Monitoring, Remote Patient Monitoring Billing, Remote Patient Monitoring CPT Codes, Revenue Cycle Management, RPM, RPM Billing, RPM CPT CodesWant to Start a Medical Billing Company?
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 an understanding of 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, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Startup, rcm, RCM Startup, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Start a Medical Billing Company, Start Your Own Medical Billing CompanyThe Need for Transparency in Medical Billing
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, Billing Systemic Reform, Billing Transparency, CMS, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Transparency, No Surprises Act, Revenue Cycle, Revenue Cycle ManagementThe Importance of Defining Medical Billing Workflows
So you run a medical practice or healthcare facility. Congrats, you’re doing important work that helps keep people healthy. But have you put much thought into your medical billing workflows? If not, you really should. Billing is the lifeblood that keeps a healthcare operation afloat financially. It’s how you get paid for the vital services […]
AI, Automation, billing, Billing Workflows, Financial Visibility, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Workflows, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, RPAThe Digitization of Medical Billing: How Electronic Systems are Streamlining the Revenue Cycle
In the dynamic, healthcare ecosystem, 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 […]
Better Patient Experience, Billing Automation, Billing Process, Digitization of Medical Billing, Electronic Medical Billing, Electronic Medical Billing Systems, Future of Medical Billing, Healthcare Billing, Healthcare Billing Systems, Medical, Medical Billing, Medical Billing Systems, Revenue Cycle, Revenue Cycle Management, Robotic Process Automation, RPAStreamline Your Medical Billing Workflow: Best Practices for Efficiency
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 complexity of payer regulations, coding intricacies, 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, Billing Challenges, Billing Workflow, Coding Intricacies, EHR, Electronic Health Records, EMR, Future-Proof, healthcare, Healthcare Billing, Interoperability Standards, Medical, Medical Billing, Medical Billing Service, Medical Billing Workflow, NLP, Payer Regulations, Practice Management Systems, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Streamlined Medical Billing WorkflowGenetic Testing: Navigating the Complex Landscape of Coverage and Reimbursement
The field of genetics has experienced remarkable advancements in recent years, revolutionizing our understanding 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 a complex landscape of coverage and reimbursement challenges. […]
billing, Coverage and Reimbursement, DNA, DNA Testing, genetic testing, genetic testing billing, Genetic Testing Coverage, Genetic Testing Coverage and Reimbursement, Genetic Testing Reimbursement, Genetics, healthcare, Medical Billing, Medical Billing Service, rcm, Regulatory Bodies, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationHow Leading Providers Optimized Their RCM Performance
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. In this article, […]
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 IntegrityEssentials of Revenue Optimization in Healthcare
The healthcare industry is undergoing massive changes. With rising costs, declining reimbursements, and shift towards value-based care, healthcare providers face significant financial pressures. At the same time, patients demand superior access, quality, and lower out-of-pocket costs. To thrive in this environment, healthcare organizations must adopt a strategic approach to revenue optimization. Revenue optimization involves systematically […]
Better Payer Contracts, billing, Clinical Documentation, healthcare, Healthcare Billing, Medical, Medical Billing, patient payments, rcm, Renegotiate Payer Contracts, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Integrity, revenue optimization, Value Based Care, Value Based SystemWhich CPT Codes are Used in Breast Cancer Treatment Billing?
Breast cancer is one of the most common cancers among women in the United States, with about 1 in 8 women developing invasive breast cancer over their lifetime. As breast cancer incidence has increased over the past several decades, advances in screening, diagnosis, and treatment have also greatly improved. Breast cancer death rates have fallen […]
billing, Biomarker Billing, Breast Cancer, Breast Cancer Billing, Breast Cancer Care, Breast Cancer CPT Codes, Breast MRI Billing, Breast Ultrasound Billing, Cancer Billing, Cancer Screening Billing, Chemotherapy Billing, Coding, CPT codes, healthcare, Healthcare Billing, Mammography Billing, Medical, Medical Billing, Medical Billing and Coding, medical coding, rcm, Revenue Cycle, Revenue Cycle ManagementDeep Brain Stimulation (DBS) for Severe Opioid Addiction
Opioid addiction is a chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences. It is considered a major public health crisis in many parts of the world including the United States, where over 47,000 opioid overdose deaths occurred in 2017 alone. While medications and behavioral therapies can be helpful for some, […]
billing, DBS, DBS for Addiction Treatment, DBS in Addiction, Deep Brain Stimulation, Medical Billing, MFB, NAc, Neurotechnology, Neurotechnology Billing, Pathological Neurobiology, Substance Abuse BillingArtificial Intelligence (AI): Friend or Foe of Revenue Cycle Management?
Revenue cycle management (RCM) is a crucial part of running any healthcare organization. It involves everything from patient registration and eligibility verification to medical coding, charge capture, claims submissions, payment posting, denial management, and more. The goal is to maximize reimbursements while reducing costs and inefficiencies. In recent years, artificial intelligence (AI) has emerged as […]
AI, AI Bot, AI Coding, AI into RCM, AI RCM, artificial intelligence, Automated Appeal Letters, Automation, billing, healthcare, Healthcare Billing, Machine Learning, Medical, Medical Billing, NLP, rcm, RCM Automation, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationClaim Denial vs. Rejection: What’s the Difference?
In the healthcare industry, there are two main ways that insurance companies respond when they decide not to pay a claim – denial and rejection. Both indicate the claim will not be paid, but there are some important differences between the two. Understanding the distinction is critical for medical providers to correctly follow-up so they […]
Claim Denial, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Clearinghouse Rejection, Denial vs Rejection, denied claims, healthcare, Healthcare Billing, Medical, Medical Billing, Payer Rejection, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationStrategies for Dealing with Denied Claims
Dealing with denied claims is one of the most frustrating and time-consuming aspects of medical billing. However, there are several strategies billing staff can employ to efficiently handle denials, appeal them successfully, and prevent denials from occurring in the first place. This comprehensive guide will explore the most effective ways to deal with denied claims […]
billing, claim denial manager, Claim Denials, Claim Rejection, Claim Rejection Rate, denial management, Denial Prevention, Denial Prevention Strategy, Denial Trends, Denials, denied claims, Healthcare Billing, Medical Billing, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationUnveiling Some of the Key CPT Codes in Medical Coding
In the intricate world of medical billing and coding, understanding Common Procedural Terminology (CPT) codes is paramount. These codes act as a universal language, facilitating seamless communication between healthcare providers and insurance entities. Let’s delve into the realm of CPT codes, exploring their significance and shedding light on the most commonly used ones. Decoding CPT […]
Allergy Testing Billing, Behavioral Health Billing, billing, Coding, COVID-19 billing, CPT codes, DME Billing, Family Practice Billing, genetic testing billing, Healthcare Billing, Medical Billing, medical coding, Medical Reimbursement, Occupational Therapy Billing, outsourced billing, PT Billing, Revenue Cycle Management, revenue cycle optimization, speech therapy billing, toxicology billingBilling for COVID-19 Testing: An In-Depth Use Case Explaining CPT Codes, Payer Policies, and Revenue Cycle Optimization
Diagnostic testing for COVID-19 has become a cornerstone of pandemic response for healthcare providers. However, rolling out testing services presents immense challenges around reimbursement and revenue cycle management. This definitive use case walks through COVID-19 testing billing and coding procedures in 2022 step-by-step, using examples to illustrate how to optimize claims submission and payment across […]
0224U, 87426, 87635, billing, Covid, COVID billing, COVID Test Billing, COVID testing billing, COVID Tests, COVID-19, COVID-19 Test Billing, COVID-19 testing, CPT codes, Medical, Medical Billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, SARS-CoV-2, SARS-CoV-2 BillingThe Challenges and Opportunities of Digital Therapeutics (DTx) 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, […]
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, RWEBilling Workers’ Compensation: A Guide to Making Claims Through HR
Workers’ compensation provides benefits to employees who suffer job-related injuries or illnesses. It covers medical treatment, lost wages, and rehabilitation services. Workers’ comp is regulated at the state level and all businesses are required to have workers’ comp insurance. When an employee is injured on the job, they need to file a claim with their […]
healthcare, Healthcare Billing, HR, Human Resources, Insurance Adjusters, Lost Wages, Medical, Medical Billing, Revenue Cycle, Revenue Cycle Management, Workers' Comp, Workers' Compensation, Workers' Compensation Billing Process, Workers’ Comp Claim, Workers’ Compensation Billing, Workmans CompManual Medical Billing is Dead, RPA is the Answer
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 […]
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 AdoptionWhat are and When to Use Modifier Codes
Modifier codes are an important part of medical billing and coding. They provide additional information about a medical procedure or service to help ensure proper reimbursement. Knowing when to use modifier codes can improve claim accuracy and prevent costly payment delays or denials. This comprehensive guide will explain what modifier codes are, why they are […]
Anatomic Modifiers, Bilateral Surgery Modifiers, billing, Coding, coding and billing, CPT, CPT definitions, CPT-10, Global Surgery Modifiers, HCPCS, healthcare, Healthcare Billing, Medical, Medical Billing, medical coding, medical necessity, NCCI, NCCI Edits, payer policies, Procedure Modifiers, Revenue Cycle, Revenue Cycle Management, revenue cycle optimizationWhat’s the Difference Between Comprehensive, Component, and Modifier Codes?
Medical billing and coding is an intricate process that requires the use of different types of codes to accurately document procedures, services, diagnoses, and supplies. Three important types of codes are comprehensive codes, component codes, and modifier codes. Understanding the differences between these code types is crucial for accurate medical billing and reimbursement. Comprehensive Codes […]
-AS, -AT, -CG, -LT, -RT, adjunct services, ancillary services, billing, bundling, care settings, Component Codes, comprehensive codes, CPT Manual, healthcare, Healthcare Billing, laterality, Medical, Medical Billing, Modifier Codes, Modifiers, patient conditions, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Unbundling, unusual circumstances