Category: Medical Billing

healthcare billing

How AI Revolutionizes Healthcare Billing: Tackling Payment Delays and Denials

During pediatric cardiology internship, witnessed this firsthand. A claim filed nearly a year earlier remained unpaid. The initial denial was due to a missing prior authorization number, a detail buried within the EMR. Unfortunately, the outsourced healthcare billing team took months to decipher this information, causing significant delays in reimbursement. This year-long ordeal highlights the […]
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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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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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Modifiers 26 and Modifier TC

Modifier 26 and Modifier TC for Accurate Healthcare Billing

In the realm of healthcare billing and coding, modifiers are crucial tools used to provide additional context and specificity to procedure and diagnosis codes. These modifiers help healthcare providers accurately communicate the nature of services rendered to payers. Two commonly used modifiers, Modifiers 26 and Modifier TC, play significant roles in clarifying billing practices and […]
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Medicare appeals process

New CMS Rule: Medicare Appeals Process for Reclassified Patients

On October 11th, the Centers for Medicare & Medicaid Services (CMS) issued a final rule establishing a new Medicare appeals process for Medicare beneficiaries who are initially admitted to a hospital as inpatients but later reclassified as outpatients receiving observation services. This rule is a result of the class-action lawsuit that sought to establish appeal […]
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Medical Billing Industry

Growth in the Medical Billing Industry: Trends and Challenges

The medical billing industry, while complex and often mired in regulatory hurdles, is experiencing a period of growth and transformation. A recent survey conducted by healthcare software company, a digital health operating system company, revealed that 65% of medical billing companies hold a positive outlook on the industry’s future. This optimism is fueled by several […]
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Accounts receivable services

The Crucial Role of Accounts Receivable Services in Healthcare Practice

Accounts receivable (AR) services are often overlooked but play a crucial role in the financial health of any business. These services involve managing the process of collecting outstanding payments from customers for goods or services sold on credit. Effective AR management can significantly impact a company’s cash flow, profitability, and overall financial stability. The Importance […]
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medical claims processing

The Power of Business Process Automation in Medical Claims Processing

Medical claims processing has traditionally been a labor-intensive and error-prone task, involving manual data entry, verification, and adjudication. However, the advent of Business Process Automation (BPA) has revolutionized this process, making it more efficient, accurate, and cost-effective. Beyond the Basics: Advanced BPA Features While the core functionality of BPA in medical claims processing involves automating […]
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Prevent Coding and Billing Errors

Preventing coding and billing errors can reduce claims denials

Accurate medical coding and billing are essential components of a healthcare practice’s financial health. When codes for procedures and diagnoses are recorded correctly, providers can receive timely reimbursements for the services they deliver. However, Prevent coding and billing errors can lead to claim denials, delays in payments, and increased administrative burden This blog post will […]
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Future of Medicare telehealth

Future of Medicare Telehealth is Bright and Innovative

Medicare, the federal health insurance program for people aged 65 and older, has been at the forefront of healthcare innovation. In recent years, telehealth has emerged as a powerful tool, transforming the way healthcare services are delivered. As technology continues to advance, the future of Medicare telehealth looks increasingly promising. Telehealth: A Brief Overview Telehealth, […]
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