Billing & Credentialing Cranberry Twp. (Pittsburgh)
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  • Posts tagged "revenue cycle optimization"

Posts tagged "revenue cycle optimization"

How to Set Clear Goals for Medical Billing That Keep Your Practice Profitable

November 2, 2024 / admin / Articles, Billing, Billing Goals, Clean Claim Rate, Medical Billing, Medical Billing Goals, RCM, RCM Optimization, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
Crazy Medical Coder Biller

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. […]

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billing, Billing Goals, Clean Claim Rate, Medical Billing, Medical Billing Goals, rcm, RCM Optimization, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization

Are Medical Billing Codes Universal?

October 8, 2024 / admin / Artificial Intelligence, Billing Codes, Billing KPIs, Billing Outcomes, Blockchain, ICD, ICD Codes, ICD-10, ICD-10 to ICD-11, ICD-11, IHTSDO, Non-Universality Coding, SNOMED CT
Female Medical Coder

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, […]

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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 Care

For Medical Billers, Coding Accuracy is Valued Above All

September 21, 2024 / admin / Articles, Coding, Coding Accuracy, Coding and Billing, Coding and Documentation, Coding Intricacies, Coding versus Billing, Medical Coder, Medical Coders, Medical Coding, Medical Coding Accuracy, Medical Coding Quality
Female Medical Coder

Medical 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, […]

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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

5 Ways to Boost Revenue Cycle Management

June 4, 2024 / admin / Articles, RCM, RCM Automation, RCM Challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue Cycle, Revenue Cycle Automation, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Optimization
RCM Optimization

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, […]

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rcm, RCM Automation, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue Cycle, Revenue Cycle Automation, Revenue Cycle Management, revenue cycle optimization, revenue optimization

Revenue Cycle Metrics for Healthcare Financial Success

May 3, 2024 / admin / Articles, RCM, RCM Challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Cycle Process, Revenue Optimization
RCM Optimization

We 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 […]

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rcm, rcm challenges, RCM KPIs, RCM Metrics, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Revenue Cycle Process, revenue optimization

Want to Start a Medical Billing Company?

March 28, 2024 / admin / Articles, Billing, Billing Challenges, Billing Services, Billing Staff, Medical Billing, Medical Billing Careers, Medical Billing Startup, RCM Startup, Start a Medical Billing Company, Start Your Own Medical Billing Company
Potential Medical Billing Company Owner

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 […]

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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

The Importance of Defining Medical Billing Workflows

March 22, 2024 / admin / Articles, Artificial Intelligence, Billing, Billing Best Practice, Billing Workflows, Claim Denials, Denial Management, Denied Claims, Financial Visibility, Medical Billing, Medical Billing Workflows, Robotic Process Automation, RPA
Medical Biller Techie

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 […]

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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

Streamline Your Medical Billing Workflow: Best Practices for Efficiency

March 11, 2024 / admin / Articles, Billing, Billing Best Practice, Billing Challenges, Billing Workflow, Coding Intricacies, Interoperability, Medical Billing, Medical Billing Workflow, NLP, Payer Regulations, Robotic Process Automation, RPA, Streamlined Medical Billing Workflow
Medical Billing Workflow

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 […]

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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

Genetic Testing: Navigating the Complex Landscape of Coverage and Reimbursement

March 9, 2024 / admin / Articles, Genetic Testing, Genetic Testing Billing, Genetic Testing Coverage, Genetic Testing Reimbursement, Genetic Testing Services Billing, Medical, Medical Billing, Medical Coding, Regulatory Bodies
Genetic Testing Lab

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. […]

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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

How Leading Providers Optimized Their RCM Performance

March 6, 2024 / admin / Articles, Case Studies, Denial Analytics, Denial Management, Denial Trends, RCM, RCM Case Studies, RCM Optimization, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Cycle Process, Revenue Integrity
RCM Case Studies

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 […]

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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

Essentials of Revenue Optimization in Healthcare

March 4, 2024 / admin / Articles, Better Payer Contracts, Billing, Clinical Documentation, Patient Collections, Renegotiate Payer Contracts, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Integrity, Revenue Leakage, Revenue Optimization, Value Based Care, Value-based Care, Value-Based Models
Revenue Cycle Management Coins

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 […]

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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

Artificial Intelligence (AI): Friend or Foe of Revenue Cycle Management?

February 26, 2024 / admin / AI, AI Bot, AI Coding, AI into RCM, AI Models, AI RCM, AI-driven RCM, Articles, Artificial Intelligence, Billing, Billing AI, Medical, Medical Analytics, Medical Billing, RCM Automation, Revenue Cycle, Revenue Cycle Management
AI in RCM

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 […]

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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

Claim Denial vs. Rejection: What’s the Difference?

February 23, 2024 / admin / Articles, Claim Denial, Claim Denial Prevention, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Claims Management, Clearinghouse Rejection, Denial Management, Denial Prevention Strategy, Denial Trends, Denial vs Rejection, Denied Claims, Denied Medical Claims, Payer Rejection, Rejected Claims
Medical Claim Denied Doctor

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 […]

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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

Strategies for Dealing with Denied Claims

February 21, 2024 / admin / Articles, Billing, Claim Denial Prevention, Claim Denial Rate, Claim Denials, Claim Rejection, Claim Rejection Rate, Denial Analytics, Denial Codes, Denial Management, Denial Prevention Strategy, Denial Trends, Denials Managements, Denied Claims, Denied Medical 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. We analyze the most effective ways to deal with denied claims in medical billing. […]

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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

Unveiling Some of the Key CPT Codes in Medical Coding

February 20, 2024 / admin / Allergy Testing Billing, Articles, Behavioral Health Billing, Chiropractic Billing, Coding, DME Billing, Genetic Testing Billing, Hospital Billing, Hospitalist Billing, Lab Billing, Medical Billing, Medical Coding, Pharmacogenetics Billing, Reimbursement, Skilled Nursing Billing, Telehealth Billing, Toxicology Billing
White Female Medical Billing Outsourced

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 […]

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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 billing

Billing for COVID-19 Testing: An In-Depth Use Case Explaining CPT Codes, Payer Policies, and Revenue Cycle Optimization

February 19, 2024 / admin / Articles, Billing, Coding, Coding and Billing, Corona Virus, Corona Virus Testing Billing, Coronavirus, Coronavirus Testing, Coronavirus Testing Billing, COVID, COVID Testing Billing, COVID-19, COVID-19 Billing, COVID-19 Test Billing, CPT Codes, Revenue Cycle Management, Revenue Cycle Optimization, SARS-CoV-2 Billing
COVID-19 variant test billing

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 […]

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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 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

What are and When to Use Modifier Codes

February 10, 2024 / admin / Anatomic Modifiers, Articles, Bilateral Surgery Modifiers, CMS, Coding, CPT, CPT Codes, CPT Definitions, Global Surgery Modifiers, HCPCS Codes, Medical, Medical Billing, Medical Coding, Missing Modifiers, Modifier Codes, Modifiers, Procedure Modifiers
Medical Billing White Guy

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. We explain what modifier codes are, why they are used, the most […]

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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 optimization

What’s the Difference Between Comprehensive, Component, and Modifier Codes?

February 9, 2024 / admin / Articles, Billing, Bundled Payments, Bundling, Component Codes, Comprehensive Codes, CPT Manual, Healthcare, Healthcare Billing, Medical, Medical Billing, Modifier Code, Modifiers, Unbundling
Medical CPT 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 […]

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-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

The Essential Guide to Medical Billing Automation

January 31, 2024 / admin / AI, Articles, Artificial Intelligence, Automated Billing, Automation, Billing, Billing Automation, Cloud-based Automation, Healthcare Billing, Medical Billing, Medical Billing Automation
Medical Billing versus Sports

Medical practices are constantly looking for ways to improve efficiency and increase revenue. Yet many practices are still relying on manual, paper-based billing processes that are tedious, error-prone, and time-consuming. In today’s digital age, automated medical billing is a must for any practice that wants to streamline operations, get paid faster, reduce denied claims, and […]

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AI, artificial intelligence, automated billing, automating billing, billing, Billing Automation, Cloud-based automation, EHR, Healthcare Billing, Medical, Medical Billing, Medical Billing Automation, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA

10 Trends Set to Transform Medical Billing

January 28, 2024 / admin / Analytics, Articles, Changing Regulations, Cybersecurity, Medical Billing, Medical Billing Trends, Outsourcing, Patient Consumerism, Payment Models, Revenue Cycle Management, Robotic Process Automation, RPA, Virtual Care

The healthcare industry is rapidly evolving, driven by advances in technology, changes in regulations, and shifts in consumer behavior. For medical billing professionals, these changes bring both opportunities and challenges. Staying up-to-date on the latest trends is key to remaining competitive and providing the best possible service to healthcare providers. We’ll explore the top 10 […]

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artificial intelligence, Big Data, Billing RPA, Changing Regulations, Cybersecurity, healthcare, Medical Analytics, Medical Billing, Medical Billing Analytics, Medical Billing Trends, Patient Consumerism, Payment Models, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, RPA, telehealth, Virtual Care

How to Take Your Medical Billing to the Next Level in 2024

January 27, 2024 / admin / Articles, Billing, Billing AI, Billing Automation, Billing Best Practice, Billing Revenue, Billing Services, Claims Management, Coding, Denial Codes, Denial Management, Denial Trends, Denied Claims, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing AI, Medical Billing Analytics, ROI

Medical billing is a complex and ever-evolving field. With constant changes in regulations, coding guidelines, reimbursement rates, and technology, medical billing services must continuously adapt and improve to stay competitive. Taking your medical billing to the next level requires focusing on efficiency, optimization, training, and utilizing the latest tools and software. Implementing the strategies outlined […]

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clearinghouse, EDI, healthcare, Healthcare Billing, Medical, Medical Billing, medical billing strategy, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Robotic Process Automation, ROI, RPA

Revenue Cycle Management Consulting: Maximizing Medical Revenue Capture

January 26, 2024 / admin / Articles, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management (RCM), Revenue Cycle Management Challenges, Revenue Cycle Management Consulting, Revenue Integrity, Revenue Leakage
Revenue Cycle Management Coins

Revenue cycle management (RCM) is a critical component of running a successful and financially stable medical practice. However, with the complexity of medical billing and constantly changing payer rules, many healthcare providers struggle to manage their revenue cycle effectively. This results in lost revenue due to suboptimal reimbursement rates, denial rates, collection rates, and other […]

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billing, healthcare, Healthcare Billing, Medical, Medical Billing, rcm, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management Consulting, revenue cycle optimization, Revenue Leakage, Robotic Process Automation

How to Connect an EHR to a Clearinghouse: A Step-by-Step Guide

January 23, 2024 / admin / Articles, Clearinghouse, EHR, EHR API, EHR Integration, EHRs, Electronic Claims, EMR, EMR Integration, Health Level 7, Healthcare, HL7, HL7 FHIR, HL7 messaging, HL7 Standard, Interoperability, Medical, Medical Billing, Medical Billing AI

Electronic health records (EHRs) have become an indispensable part of healthcare operations. EHRs allow providers to store patient information electronically and share it securely. However, to transmit claims and other data to payers, providers need to connect their EHR system to a clearinghouse. A clearinghouse acts as an intermediary between providers and insurance companies by […]

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clearinghouse, EHR, EMR, healthcare, Healthcare Billing, HL7, HL7 interface, HL7 interoperability, HL7 messaging, HL7 Standards, Medical, Medical Billing, Revenue Cycle Management, revenue cycle optimization

Medical Billing versus the Sports World: An Unlikely Comparison

January 21, 2024 / admin / Articles, Artificial Intelligence, Billing, Billing Revenue, Billing Services, Claim Billing, Data Management, Healthcare, Healthcare Billing, Medical Billing, RCM, Revenue Cycle, Revenue Cycle Management, Sports
Medical Billing versus Sports

At first glance, medical billing and professional sports seem to occupy opposite ends of the career spectrum. However, there are interesting parallels in how these two worlds operate when it comes to finances, data, and competition. Drawing comparisons between the healthcare administration and athletics provides unique insights that billing professionals can apply to enhance their […]

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AI, artificial intelligence, Claim Data, Data, healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, outsourced billing, outsourced medical billing, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, sports, sports vs billing
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