Category: Blog

Charge Capture in Healthcare

Charge Capture: A Critical Step in Revenue Cycle Management

Charge Capture in Healthcare, a critical component of the revenue cycle management process, involves the accurate and timely documentation of all services rendered to patients. This includes procedures, tests, medications, and other healthcare services. While it may seem like a simple task, effective healthcare charge capture is essential to ensure optimal revenue cycle performance and […]
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Mastering Chronic care management codes

Chronic Care Management Codes: A Comprehensive Guide

Chronic Care Management codes are increasingly being adopted by healthcare providers to address care fragmentation for patients with multiple chronic conditions. However, a recent study published in the American Academy of Family Physicians suggests that while CCM is gaining traction, challenges persist in its implementation and reimbursement. A Growing Trend The study, which analyzed Medicare […]
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Healthcare Claims Management

Healthcare Claims Management: Overcoming Denials and Optimizing Revenue Cycle

Claim denials continue to pose a significant challenge to healthcare claims management. Recent surveys indicate a substantial increase in denial rates, with many providers experiencing denial rates exceeding 10%. This issue has far-reaching consequences, impacting operational efficiency, financial stability, and ultimately, patient care The High Cost of Denials Healthcare providers face substantial financial losses due […]
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Thanksgiving ICD-10 codes

11 Crazy ICD-10 Codes for Thanksgiving

Thanksgiving Day, while a time for celebration and gratitude, can sometimes present unforeseen medical challenges. To assist healthcare providers in accurately coding these instances, we have compiled a list of relevant Thanksgiving ICD-10 codes.  Here are a couple of Thanksgiving ICD-10 codes you might find useful this Thanksgiving season: W61.43: Pecked by a Turkey, Initial […]
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Optimizing RCM

Optimize Revenue Cycle Management: Strategies for Value-Based Care

The healthcare industry continues to face significant challenges, driven by value-based care initiatives, evolving payer models, and increasingly stringent regulations. To optimize revenue cycle management and ensure financial sustainability, healthcare providers must adapt to these changes . The COVID-19 pandemic exacerbated these challenges, leading to historically low margins and high costs, particularly in labor. Simultaneously, […]
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Modifier 25

Understanding Modifier 25: A Comprehensive Guide

Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
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Healthcare payment integrity

How AI and Automation are Revolutionizing Payment Integrity in Healthcare

Healthcare payment integrity is a crucial aspect of efficient claims processing, and its improvement can significantly reduce costs and improve patient care. Healthcare costs continue to climb, burdening patients, providers, and insurers alike. A significant driver of this issue is the inefficiency of healthcare administration, particularly in claims processing. Despite standardized claim formats, outdated systems […]
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claim denial management

Claim Denial Management: A Comprehensive Guide

Claim denials are a common challenge for healthcare organizations, often leading to significant revenue loss. While it’s impossible to eliminate denials entirely, proactive Claim denial management can significantly reduce their impact. Industry standards for claim denials are lacking, making it difficult to track and analyze denial trends. Each payer has its own unique policies and […]
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medicare telehealth policy changes

Medicare Telehealth Policy Changes: What Patients and Providers Need to Know

Medicare Telehealth Policy Changes are set to reshape the landscape of telehealth services. As the COVID-19 public health emergency ends, Medicare will revert to pre-pandemic policies, imposing stricter rules for telehealth services starting January 1, 2025, unless Congress intervenes. Key changes include: Geographic Restrictions: Patients must generally live in a health professional shortage area, a […]
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External Coding Audit

The Role of External Coding Audits in Healthcare

The constant updates in medical codes and evolving payer regulations, healthcare providers are increasingly turning to external coding audits. This blog post explores the importance of external coding audits, benefits, and how they support the healthcare industry in minimizing compliance risks, improving revenue integrity, and enhancing operational efficiency. 1. What Is an External Coding Audit? […]
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