Category: Blog

Reducing Claim Denials

Mastering Healthcare Claim Denial Management: Strategies & Solutions

In healthcare, claim denials pose a significant challenge to a provider’s revenue cycle. Each year, over $4.5 trillion in claims are submitted to insurance carriers in the U.S. alone. Despite this volume, healthcare providers continue to see an alarming rise in denied claims. In 2022, 42% of respondents reported an increase in denials, but by […]
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RCM Compliance Challenges

Top 10 Revenue Cycle Management Compliance Challenges

Revenue cycle management (RCM) is the financial backbone of any medical practice, ensuring timely reimbursement while maintaining compliance with ever-evolving regulations. However, many practices unknowingly face significant compliance risks that can lead to claim denials, audits, financial penalties, and even legal consequences. Common pitfalls include billing and coding errors, fraud and abuse violations, HIPAA breaches, […]
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Urology Billing and Coding

Urology Billing & Coding Errors and How to Prevent Them

Urology practices face unique challenges when it comes to billing and coding. The complexity of urological procedures, coupled with ever-changing coding guidelines, can lead to costly errors, claim denials, and revenue loss. Accurate and efficient billing is crucial for the financial health of any urology practice. This blog post will delve into common urology billing […]
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Medicare reimbursement cuts

Medicare reimbursement cuts and their impact on private practice physicians

Medicare is failing both patients and physicians. After adjusting for inflation, physician reimbursement under Medicare has declined by 33% from 2001 to 2025, according to the American Medical Association. In stark contrast, Medicare payments to hospitals have surged by nearly 60%, while hospital executive salaries have skyrocketed 93% over the past decade. How can private […]
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Manual Claims Denial Management

Why Manual Denial Management is Hurting Your Revenue

Healthcare providers face mounting financial pressures due to rising operational costs, evolving regulatory requirements, and shrinking reimbursement rates. One of the most critical areas affecting revenue cycle efficiency is claims denial management. Despite advancements in technology, many healthcare organizations still rely on manual claims denial management, leading to inefficiencies, revenue leakage, and administrative burdens. This […]
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Code Updates for Chiropractic Practices

Key 2025 ICD-10 Code Updates for Chiropractic Practices

Selecting a diagnosis code based solely on intuition is not enough. Each diagnosis must be supported by clear clinical rationale, documented in the care plan, and recorded in the patient’s chart notes. Staying informed about Code Updates for Chiropractic Practices ensures accuracy, compliance, and proper reimbursement for services rendered. Coding Best Practices Symptom vs. Diagnosis […]
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Therapy Services Codes

Therapy Services Codes: A Complete Guide to CPT & HCPCS Codes

Therapy services play a vital role in healthcare, helping patients recover from injuries, manage chronic conditions, and improve overall well-being. To ensure accurate billing and reimbursement, healthcare providers must use the correct therapy services codes. These codes, primarily based on the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), help standardize claims […]
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healthcare compliance issue Logs

Healthcare Compliance Issue Logs & Risk Assessment

Troubleshooting and insurance: These are the dual purposes of maintaining a detailed Healthcare Compliance Issue Logs, according to a senior compliance executive. Speaking at AAPC’s HEALTHCON Regional, the senior compliance executive highlighted the Office of Inspector General’s (OIG) new voluntary compliance guidance, emphasizing its importance even for organizations already familiar with the seven elements of […]
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New Medicare enrollment application

New Medicare Enrollment Application: A Comprehensive Guide

Enrolling in Medicare can feel like navigating a maze of paperwork and deadlines. This comprehensive guide aims to simplify the process, focusing specifically on the new Medicare enrollment application. We’ll break down the different parts of the application, explain eligibility requirements, discuss enrollment periods, and offer tips for a smooth and successful enrollment experience. Understanding […]
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Prior Authorizations

Prior Authorization in Medicare: What You Need to Know

Prior authorization, the requirement for pre-approval from your insurer for certain services, is a common practice in both Original Medicare and Medicare Advantage (MA) plans. While it helps manage utilization and costs, it can also be frustrating, especially when a request is denied. A 2023 study by health policy research revealed the increasing prevalence of […]
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