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. […]
billing, Billing Goals, Clean Claim Rate, Medical Billing, Medical Billing Goals, rcm, RCM Optimization, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization
In healthcare revenue cycle management, few metrics carry as much weight as the Clean Claim Rate (CCR). This crucial key performance indicator (KPI) serves as a fundamental measure of a healthcare organization’s billing efficiency and effectiveness. As healthcare providers face increasing pressure to optimize their revenue cycles while maintaining high-quality patient care, understanding and improving […]
billing, Billing KPIs, CCR, Claim Denial, claim denial prevention, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Clean Claim Rate, Revenue Cycle, Revenue Cycle Management
Medical billing codes are the backbone of healthcare administration worldwide, serving as a standardized way to communicate diagnoses, procedures, and treatments between healthcare providers, insurers, and government agencies. However, the question of whether these codes are truly universal is complex and multifaceted. We dissect the various medical coding systems used globally, their similarities and differences, […]
billing, CPT, CPT codes, EHR, EMR, Healthcare Billing, ICD-10, ICD-10 coding, ICD-11, IHTSDO, Medical Billing, Non-Universality Coding, outsourced billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA, SNOMED CT, Systematized Nomenclature of Medicine, Value Based CareMedical billing stands as a crucial link between healthcare providers and payers. At the heart of this process lies a fundamental principle that every medical biller must embrace: the paramount importance of accuracy in coding. We delve deep into why coding accuracy is not just a best practice, but an absolute necessity in medical billing, […]
billing, Coding, Coding Accuracy, coding and billing, Coding and Documentation, Coding Intricacies, Coding versus Billing, Medical Billing, Medical Coder, Medical Coders, medical coding, Medical Coding Accuracy, Medical coding quality, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization
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 […]
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
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, […]
rcm, RCM Automation, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue Cycle, Revenue Cycle Automation, Revenue Cycle Management, revenue cycle optimization, revenue optimizationWe 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 […]
rcm, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Cycle Process, revenue optimization
If you’re in the healthcare industry or deal with professionals who need to be credentialed, you know how complex and time-consuming the whole process can be. From verifying licenses and certifications to checking work histories and malpractice claims, credentialing is a massive headache that never seems to end. But here’s the thing – you don’t […]
Credentialing, Credentialing Accuracy, Credentialing AI, Credentialing and Contracting, Credentialing New Providers, credentialing on-boarding, medical credentialing, Medical Credentialing AI, rcm, Revenue Cycle, Revenue Cycle Management
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 […]
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
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 Management
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 Company
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 […]
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
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 Management
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, RPA
In the 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 process and […]
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, RPA
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 Workflow
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 optimization
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 […]
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
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 System
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 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 optimization
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 optimization
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. We analyze the most effective ways to deal with denied claims in medical billing. […]
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 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 Billing
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, RWE