Category: Blog

Healthcare Claim Denials

Reduce Healthcare Claim Denials and Improve Revenue: Proven Strategies

Healthcare Claim Denials can be a frustrating and costly setback. However, with the right strategies, you can significantly reduce denials and improve your revenue. This article outlines four effective approaches to handling denied claims and ensures timely resubmissions. 1. Establish a Routine for Denial Handling Create a standardized procedure: Develop a clear and efficient process […]
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medical coding and CDI

Unlocking AI Power for Medical Coding and CDI: Essential Features

 Unlocking the Power of AI: Essential Features for Medical Coding and CDI Tools: When choosing an AI tool to improve medical coding or clinical documentation integrity (CDI), healthcare organizations navigate a complex landscape of emerging technologies. To ensure the right selection, focus on key features that enhance accuracy, efficiency, and compliance. One crucial aspect is […]
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HIPAA-compliant cloud computing

Mitigating Security Risks in Healthcare with HIPAA-Compliant Cloud Computing

The Role of HIPAA-Compliant Cloud Computing in Securing Healthcare Data: HIPAA-compliant cloud computing significantly mitigates security, privacy, and legal risks for healthcare organizations. Cloud computing is becoming increasingly popular in healthcare. As organizations seek scalable and accessible IT solutions, cloud vendors are providing the tools. However, ensuring HIPAA compliance is essential when using cloud services. […]
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Prior Authorization Burdens

Addressing Prior Authorization Burdens: Recent Reforms and Expert Perspectives

The prior authorization burdens associated with the process have long been a source of frustration for healthcare providers and patients. These burdens can impede optimal care by creating delays in treatment and increasing administrative tasks. However, recent legislative changes and insurer policies aim to alleviate these concerns and streamline the prior authorization process. A radiation […]
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AI-Driven Coding Automation

AI-Driven Coding Automation: The Future of Reimbursement Capture

AI-driven coding automation can save your practice countless hours each week, allowing physicians and staff to focus on higher-value tasks. This innovative technology is set to revolutionize the coding process entirely. In the future, it’s likely the healthcare industry will look back and wonder, “How did we ever manage coding without AI?” Now, let’s dive […]
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Surgery Modifiers

Surgery Modifiers Require Specific Documentation

Using surgery modifiers to accurately represent the role of assistant surgeons has become increasingly important over the past three decades. Initially, a simple mention of the assistant surgeon’s name in the operative note header sufficed. However, as the healthcare landscape evolved, payers began demanding more granular details about the assistant surgeon’s role and contributions to […]
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2025 Medicare payment policies

Proposed Medicare Payment Policies for 2025

The United States Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) have proposed new 2025 Medicare payment policies for hospitals and ambulatory surgical centers (ASCs) that aim to increase access to care and advance health equity. These policies are outlined in the 2025 Hospital Outpatient Prospective Payment System […]
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Modifier 50

Mastering Modifier 50: Ensure Accurate Billing for Bilateral Procedures

Modifier 50 is used to indicate that a procedure or service was performed on both sides of the body during the same operative session. It’s essential to use this modifier correctly to ensure accurate billing and reimbursement. Key points for appropriate use: Bilateral Procedures: The procedure must be performed on identical, opposing structures (e.g., eyes, […]
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Medicare Advantage Market

Medicare Advantage Market Trends: Growth, Challenges, and Opportunities

Medicare Advantage (MA) has become a dominant force in the Medicare landscape, accounting for over 54% of overall Medicare enrollment. This trend is expected to continue, with penetration rates projected to reach 64% by 2033.  However, the future of the Medicare Advantage market is not without its challenges. The Slowdown Begins While MA has experienced […]
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