The authorization number is right there in the system. It says approved. And 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 is one of the more frustrating gaps in revenue cycle work, because everything on […]
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
Verification of Benefits, commonly called VOB, is the process of confirming a patient’s insurance coverage details before services are rendered. A complete VOB check establishes the patient’s active coverage status, deductible amounts and how much has been met, copay and coinsurance obligations, prior authorization requirements for the planned services, and whether the provider is in-network […]
Medical Billing, Verification of Benefits, VOB, What's a VOB?
Average Revenue Per Encounter (ARE) is the total net revenue a medical practice collects divided by the total number of patient encounters over a given period. The formula is straightforward: Total Revenue Collected divided by Total Number of Patient Encounters equals ARE. A practice that collected $90,000 last month across 600 patient visits has an […]
Average Revenue Per Encounter, Average Revenue Per Patient Encounter, Coding and Billing, Medical Billing
Getting paid for the healthcare services you provide should be straightforward. 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 each month. If you’re tired of seeing rejection letters pile up on […]
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
Medical billing isn’t exactly 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 Often Fall Short Traditional […]
Billing Goals, Medical Billing, Revenue Cycle Management, SMART goals
The healthcare industry is on the cusp of a significant transformation with the introduction of the International Classification of Diseases, 11th Revision (ICD-11). This comprehensive 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
You run a medical practice or a healthcare facility, and the clinical side of the job is demanding enough without billing chaos on top of it. But if nobody has ever sat down and mapped out your practice’s actual billing workflow, step by step, that gap is costing you money right now. Billing is what […]
Billing Best Practice, Denial Management, Financial Visibility, Medical Billing, Revenue Cycle Management
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 Codes: […]
CPT Codes, Medical Billing, Medical Reimbursement, Revenue Cycle Management
Speech-language pathology services 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 complex given the many types of assessments, modalities, and interventions provided. We examine the most frequently used Current Procedural Terminology (CPT) codes that speech therapists report to receive […]
CPT Codes, Evaluation Codes, Medical Billing, Speech Billing, Speech Therapy Billing
The healthcare industry has undergone massive changes in recent years, fueled by advances in technology and a shift towards patient-centered care. However, one area that still has untapped potential is the use of Health Level 7 (HL7) standards. HL7 provides a framework for exchanging clinical and administrative data between software applications used by various healthcare […]
EHR Integration, FHIR, Interoperability, Medical Billing, RPANursing 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 post-surgical patients, those with newly diagnosed illnesses requiring education and management, individuals […]
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
The COVID-19 pandemic triggered an explosion in telehealth utilization across healthcare. While telehealth billing processes matured during the public health emergency, new complexities 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 monitoring, mental health apps, and more. We […]
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
Urgent care clinics have become an increasingly popular option for patients seeking prompt medical attention for non-life-threatening conditions. These facilities provide convenient, affordable, and timely care for a wide range of illnesses and injuries that are too severe to wait for a scheduled appointment but not serious enough to warrant a visit to the emergency […]
Articles, Billing, Billing Codes, E/M codes, E/M coding, Healthcare, Healthcare Billing, ICD-10, ICD-10 coding, Medical Billing, Medical Billing and Coding, Procedural Codes, Procedure Modifiers, Urgent Care Billing, Urgent Care CPT Codes, Urgent Care Diagnosis Codes, Urgent Care Modifiers
An Explanation of Benefits (EOB) plays a crucial role in helping patients understand the costs and coverage associated with their healthcare services. An EOB is a document that provides a detailed breakdown of a medical claim, outlining the services rendered, the amount billed, the insurance coverage, and the patient’s financial responsibility. Let’s delve deeper into […]
Billing, EOB, EOBs, Explanation of Benefits, Explanation of Benefits (EOBs), Explanation of Medical Benefits, Healthcare, Healthcare Billing, Medical, Medical Billing, OMB, OMBsIn 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 […]
CPT, Healthcare, Healthcare Billing, ICD, Medical, Medical Billing, Medical Billing Service, Medical Billing Software, Medical Credentialing, RCM, Revenue Cycle, Revenue Cycle Management
Efficient and accurate medical billing is crucial for healthcare providers and patients alike. Whether it’s handling billing for new or established patients, understanding the intricacies of medical billing practices is essential. We take an in-depth look into the key aspects of medical billing for new and established patients, exploring the differences, challenges, and best practices […]
Medical Billing, Medical Billing Service, Medical Billing Strategy, Outsource Billing, Outsource Medical billing, Outsourced Billing, Outsourced Medical Billing, Revenue Cycle Management, Revenue Cycle Optimization
As a medical biller or coder, choosing the correct Current Procedural Terminology (CPT) code is crucial for accurate reimbursement. However, with thousands of codes available, it can be overwhelming to find the right one for your services. We offer a free step-by-step guide on how to choose the correct CPT code for your medical billing […]
Billing, Correct CPT Code, CPT, CPT Billing Codes, CPT Code, CPT Codes, CPT-10, CPT-10 Codes, Healthcare, Healthcare Billing, Medical, Medical Billing
As medical technology continues to evolve, so does the way we manage and pay for healthcare. One area in particular that has seen significant changes in recent years is medical billing. Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for medical services […]
AI, Artificial Intelligence, Billing, Billing Services, Healthcare, Healthcare Billing, HIPAA, HIPAA Compliant, Medical, Medical Billing, Medical Billing AI, Telehealth, Telemedicine
Durable Medical Equipment (DME) 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. Other examples of DME products include enteral feeding […]
DME, DME Billing Service, DME CPT Codes, Medical Billing
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 […]
Medical, Medical Billing, Medical Billing Service, Outsource Billing, Outsource Medical billing, Outsourced Billing, Outsourced Medical Billing, RCM, Revenue Cycle Management
Toxicology testing is the analysis of biological samples, such as urine or blood, to detect the presence of drugs or other substances. The results of these tests can be critical in determining a patient’s treatment plan, medication management, or drug rehabilitation program. Toxicology labs play a crucial role in the diagnosis and treatment of various […]
CPT, CPT Codes, CPT-10, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Toxicology, Toxicology Billing, Toxicology CPT Codes, Toxicology Lab Billing, Toxicology Laboratory Billing