Category: Blog

EHR and RCM

Understanding the Relationship Between EHR and RCM

Amongst the many benefits of implementing an electronic health records (EHR) platform, two are fundamental: increasing the overall quality of patient care and improving business efficiency and revenue. While it can often be difficult to visualize the connection between these two sides of hospital operations, these two outcomes are linked together. Transitioning to a new […]
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Blue Shield to Require Electronic Claim Submission

On October 26, Blue Shield of California notified physicians that for new or renewing provider agreements for 2018, it will begin requiring practices to submit their claims electronically. All claims, with the exception of those with an accompanying medical record, will be required to be submitted via electronic data interchange (EDI). A complete list of […]
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5 Common Remark Codes For The CO16 Denial

5 Common Remark Codes For The CO16 Denial

co16 denial code description: The CO16 denial code is used in medical billing to indicate that a claim has been denied because it lacks necessary information or contains errors. It falls under the category of “Contractual Obligation” (CO) denials, which means the responsibility falls on the provider to fix the issue and resubmit the claim. […]
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Payer Pre-Authorization

Improving ASC Upfront Collections: 5 Fundamental Steps In Obtaining Payer Pre-Authorization

Your ASC’s surgery scheduler has just scheduled a procedure for next week. Prior to performing this procedure, there are numerous steps required to ensure that your ASC is properly compensated for services performed. Pre-authorization — also called pre certification, prior authorization, insurance verification and prior approval — from the patient’s payer is just one vital […]
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Claim denial cost

How Much Do Claim Denials Cost Hospitals? New Report Says $3.5M

Hospital and health systems have seen an improvement in some aspects of revenue cycle performance over the last two years, but a new report finds that many organizations are under pressure and face risks from increased denial write-offs, bad debt and inefficiencies due to high collection costs. Indeed, the Advisory Board’s biennial revenue cycle survey […]
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Mastering Appeals

When Appeals Are Not Enough

If you are as enthusiastic about medical billing and reimbursement, it can be vexing when we receive a denial. Here are some tried and true points that every biller should know to address a true appeal correctly. Know Your Coding: In today’s multi-tasking office you will often find billers who are certified in both collections […]
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CMS Finalizes MPFS Payment and Policy Changes

CMS Finalizes 2018 MPFS Payment and Policy Changes

The Centers for Medicare & Medicaid Services (CMS) has finalized 2018 payments and policies under the Medicare Physician Fee Schedule (MPFS). Most notable is the leniency in adopting federally-mandated policies. MPFS Final Rule Highlights: Taking into account the 0.5 percent automatic adjustment under the Medicare Access and CHIP Reauthorization Act (MACRA), CMS estimates the resource-based […]
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10 Revenue Cycle Tips For Healthcare Organizations

How Physicians Can Stabilize Revenue? Stabilize Your Revenue With These Tips

Physician practices are facing confusion and frustration due to the shift to value-based care and the ever-rising cost of care. Physicians seeking to stabilize their revenue amidst this chaos typically find themselves facing several challenges. 1. Collecting Patient Payments: Enrollment in high-deductible health plans is growing rapidly, leaving patients responsible for a larger portion of […]
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CMS Releases Physician Fee Schedule

CMS Releases Physician Fee Schedule For 2018: 6 Things To Know

CMS issued its 2018 Medicare Physician Fee Schedule, which cuts Medicare payments for services provided by certain provider-owned off-campus hospital departments. Here are six things to know about 1,250-page final rule: 1. Physician payment rates will increase 0.41 percent in 2018 compared to this year: CMS arrived at this increase after accounting for a 0.5 […]
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