Category: Medical Billing

Inaccurate Medical Bills

How to Avoid and Correct Inaccurate Medical Bills

Inaccurate medical bills can be a frustrating and costly experience for patients. From coding errors to duplicate charges, these mistakes can lead to financial strain and unnecessary stress. Understanding the common causes of Medical billing errors and taking proactive steps can help you avoid these issues. Common Causes of Inaccurate Medical Bills 1. Medical Coding […]
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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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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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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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MA Prior Authorization Denials

Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
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Coverage Denials

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
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medical billing audit services

Optimize Billing Practices with Medical Billing Audits

A domestic medical billing audit is an operation that inspects and estimates the value and dependability of clinical documentation and the overall medical billing process. This technique closely examines health records upheld by the practice and evaluates medical billing data presented to the payers to make sure that the practice picks out, observes, and rectifies […]
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