Category: Blog

value-based contracts

Reducing Quality Measure Overload in Value-Based Contracts for Primary Care Physicians

With the proliferation of quality measures in value-based contracts, many primary care physicians feel overwhelmed and set up to fail. Research conducted at the healthcare system shows that these clinicians are inundated with an excessive number of quality metrics, often leading to administrative burdens and reduced patient care. One of the primary criticisms of value-based […]
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Q4 HCPCS Level II code

Q4 2024 HCPCS Level II code Update: new Codes, Descriptor Changes, more

The Centers for Medicare & Medicaid Services (CMS) has announced updates to the Q4 HCPCS Level II code, effective October 1, 2024. These changes include: 58 new codes 10 codes with updated descriptions 6 discontinued codes Key Changes: New codes for medical and surgical supplies, outpatient procedures, durable medical equipment, and orthotic procedures. Replacement code […]
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AI in RCM

AI in RCM: Overcoming Challenges and Enhancing Efficiency

In response, many providers are turning to AI in RCM to alleviate these pressures, leveraging automation to streamline claims processing, improve documentation accuracy, and reduce denials.” This integrates the keyword smoothly while keeping the focus on the challenges faced by healthcare providers and how AI in RCM can help address them. Healthcare providers are facing […]
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Denial prevention

Denial Prevention: A Strategic Imperative for Revenue Cycle Management

Denial prevention has become a paramount focus within healthcare revenue cycles, as the financial toll of claim denials continues to rise. The increasing use of artificial intelligence (AI) by payers has further exacerbated this challenge. To mitigate these losses, a strategic shift is necessary, transitioning from a reactive approach of managing denials post-occurrence to a […]
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outsourcing Revenue Cycle Management

Outsourcing Revenue Cycle Management Services: A Solution for Independent Physicians

Independent physicians, while passionate about patient care, often find themselves entangled in the intricate web of financial management. This has become increasingly challenging with the shift towards value-based care and the growing complexity of payer contracts. Outsourcing Revenue cycle management (RCM), the process of managing financial operations from appointment scheduling to claim settlement, has emerged […]
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insurance coverage denials

How to Fight Surprise Medical Bills and Coverage Denials: A Proven Strategy

Have you recently received a surprising medical bill or had your insurance coverage denials for a recommended treatment? Unfortunately, you’re not alone. A recent national survey by the Commonwealth Fund, a leading healthcare research organization, found that a significant number of insured Americans face these challenges. While many may choose not to contest these issues, […]
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ma reform

Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage (MA) plans, a type of private health insurance that serves as an alternative to traditional Medicare, have long been a subject of debate within the healthcare industry and among policymakers. However, recent political developments suggest a growing appetite for MA reform, marking a significant departure from previous bipartisan consensus. A Rising Tide of […]
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Financial impact of VBC

Navigating the Financial Impact of Value-Based Care (VBC)

The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
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