The healthcare industry is in a perpetual state of change. A significant milestone occurred when the United States mandated the use of ICD-10 billing codes. This shift transformed billing procedures for medical providers, from solo physician practices to large hospitals. As a result, ICD10 medical billing outsourcing has become a critical solution for managing the […]
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 […]
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 […]
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 […]
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, […]
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 […]
As diabetes prevalence increases, the importance of diabetes self-management training (DSMT) and medical nutrition therapy (MNT) becomes undeniable. To empower patients, optimize health outcomes, and ensure sustainable access, healthcare systems must integrate DSMT and MNT into diabetes care protocols. This article highlights the critical role of registered dietitians (RDs) and nutrition professionals in providing these […]
With over 67 million Americans—nearly 20% of the population—relying on Medicare, the program plays a crucial role in ensuring access to quality healthcare. Unfortunately, looming Medicare physician reimbursement cuts threaten to undermine this vital service, potentially leading to reduced access to care and compromised patient outcomes Medicare physician reimbursement cuts, such as the proposed 2.8% […]
The U.S. healthcare industry, marked by its global leadership in spending, faces mounting pressures due to evolving care models, supply chain disruptions, regulations, labor shortages, and rising costs. To navigate these challenges, healthcare leaders are prioritizing quality care delivery while also optimizing administrative operations, including revenue cycle management (RCM). Outsourcing RCM has become a key […]
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 […]