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
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. The distinction is critical for medical providers to correctly follow-up so they can get claims paid appropriately. Let’s […]
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, Digital Therapeutics, 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
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 Comp
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 Adoption
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 […]
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
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
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 […]
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
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 […]
Clearinghouse, EDI, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Strategy, RCM, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation, ROI, RPARevenue 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 […]
Billing, Healthcare, Healthcare Billing, Medical, Medical Billing, RCM, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Management Consulting, Revenue Cycle Optimization, Revenue Leakage, Robotic Process AutomationAt 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 […]
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
The healthcare industry is facing a critical staffing shortage that is impacting medical billing operations and revenue cycle management. With an aging population and expanded access to healthcare, the demand for healthcare services is rising. However, there is a shortage of healthcare workers, including medical billers and coders, to meet this growing demand. This is […]
Billing, Billing Staff, COVID billing, COVID-19, Healthcare, Healthcare Billing, Medical Billing Staff, Medical Coding, Outsource Billing, Outsource Medical billing, Outsourced Billing, Outsourced Medical Billing, RCM, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation
Cases of a new COVID-19 variant, temporarily designated JN.1, are rising rapidly nationwide. According to data from the U.S. Centers for Disease Control and Prevention, JN.1 now accounts for 44% of all COVID-19 infections in the country. That represents more than double its share compared to just a week prior, highlighting the dramatic growth rate […]
COVID billing, COVID Testing, COVID testing billing, COVID-19, COVID-19 testing, Healthcare, Healthcare Billing, JN.1, Medical, Medical Billing, Outsourced Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
Medical billing plays a pivotal yet oft-overlooked role in provider financial stability and continuity of care operations. However, limited resources and inadequate solutions burden in-house teams trying to navigate outdated systems. The resulting claim delays, reimbursement leakage, and patient dissatisfaction has brought many practices to a breaking point. While outsourcing presents risks if not properly […]
Billing, Healthcare, Healthcare Billing, Medical, Medical Billing, Outsourced Billing, Outsourced Medical Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation, RPA
Medical billing sits at the heart of provider revenue cycles, yet few fully appreciate the complexities billing teams navigate to keep financial flows stable. Between interpreting endless payer policies, wrestling with outdated technology, and managing behind-the-scenes patient communications, it takes specialized skills to turn charges into reimbursements. It serves as the financial backbone of the […]
Healthcare Billing, Healthcare Outcomes, Medical, Medical Billing, Medical Billing Ingredients, Medical Billing Service, Outcomes, Outsourced Billing, Outsourced Medical Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation, RPA, Secret Sauce
With nearly 30 million residents, Texas maintains the second largest state population in the country. This burgeoning community includes diverse urban metropolises like Dallas, Houston, San Antonio and Austin as well as remote rural towns and border communities. The variability in patient demographics and healthcare access models across Texas locations generates pronounced impacts on medical […]
Austin Medical Billing, Dallas Medical Billing, Healthcare, Healthcare Billing, Houston Medical Billing, Medical, Medical Billing, Medical Billing Service, Outsourced Billing, Outsourced Medical Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, San Antonio Medical Billing, Texas Care Delivery, Texas Medical Billing
Medical billing involves the complex processes of coding services, generating insurance claims, managing rejection disputes, and ultimately securing optimal reimbursement for healthcare providers. With mounting administrative burdens and revenue pressures facing US healthcare systems, demand has accelerated for skilled medical billing talent. However, tight labor markets have spurred shortages. Below, we analyze the spreading adoption […]
Healthcare, Healthcare Billing, HIPAA, HIPAA Compliant, HL7, Medical, Medical Billing, Offshore Billing, Outsource Medical billing, Outsourced Billing, Outsourced Medical Billing, RCM, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation, RPA
As healthcare payers implement more rigorous utilization management programs, denial rates on medical claims have been steadily climbing – up to nearly 10-15% on average for practices based on reports. Denials directly impact revenues and practice bottom lines due to the costs of reworking and appealing claims. We offer an overview of building a denial […]
Claim Denials, Denial Codes, Denial Management, Denial Prevention Strategy, Denial Trends, Denied Medical Claims, Healthcare, Healthcare Billing, Medical Billing, Medical Billing Service, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
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 […]
(POS) Codes, Chronic Care Management, Digital Therapeutics, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, RCM, Remote Patient Monitoring, Remote Patient Monitoring (RPM), Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, RPM for Clinical Trials, Telehealth, Telehealth Billing, Telehealth Delivery, Telehealth Experience, Telemedicine, Wearable Integration
For any medical practice, timely insurance reimbursement is essential for financial viability and supporting smooth practice operations. However, elongated claim payment cycles strain cash flow and necessitate borrowing to cover costs in the interim. Below, we explore techniques to accelerate payer payments and optimize the speed of the medical revenue cycle. Diagnosing Causes of Lagging […]
Cash Flow Cycles, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Service, Medical Billing Strategy, RCM, Reimbursement, Reimbursement Rates, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization
Medical billing is a complex, numbers-driven process. To elevate revenues and efficiency, healthcare practices must constantly measure, analyze and optimize their medical billing and revenue cycle performance using key metrics. The Importance of Analytics in Medical Billing In the dynamic healthcare landscape, data is king. Medical practices that succeed at leveraging data make better decisions […]
CPT Code, Healthcare, Healthcare Billing, Medical, Medical Billing, Medical Billing Analytics, Medical Billing Service, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Robotic Process Automation
ICD-10 Codes ICD-10 codes are a set of alphanumeric medical diagnosis and procedure codes used for medical billing and clinical documentation. Maintained by the World Health Organization, ICD-10 contains about 69,000 codes compared to 13,000 in the older ICD-9 version. The codes provide specificity around body location, severity, comorbidities, and episode of care. Implementation of […]
CPT-10, Healthcare, Healthcare Billing, ICD-10, ICD-10 Code Changes, ICD-10 coding, ICD-10 Update, Medical, Medical Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization