Category: Revenue Cycle Management

Statistical extrapolation in healthcare audits

Statistical Extrapolation: Navigating Multimillion-Dollar Healthcare Audits

Imagine the chilling realization that a review of a mere 100 patient claims could trigger a demand for multimillion-dollar repayments from your healthcare organization. This is not a hypothetical scenario; it’s a stark reality faced by healthcare providers nationwide, driven by the potent auditing technique known as statistical extrapolation in healthcare audits. While the underlying […]
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Reducing Claim Denials

Mastering Healthcare Claim Denial Management: Strategies & Solutions

In healthcare, claim denials pose a significant challenge to a provider’s revenue cycle. Each year, over $4.5 trillion in claims are submitted to insurance carriers in the U.S. alone. Despite this volume, healthcare providers continue to see an alarming rise in denied claims. In 2022, 42% of respondents reported an increase in denials, but by […]
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RCM Compliance Challenges

Top 10 Revenue Cycle Management Compliance Challenges

Revenue cycle management (RCM) is the financial backbone of any medical practice, ensuring timely reimbursement while maintaining compliance with ever-evolving regulations. However, many practices unknowingly face significant compliance risks that can lead to claim denials, audits, financial penalties, and even legal consequences. Common pitfalls include billing and coding errors, fraud and abuse violations, HIPAA breaches, […]
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medical necessity documentation

Medical Necessity Documentation: A Guide to Reducing Claim Denials

Claim denials are a significant headache for healthcare providers, impacting revenue and administrative efficiency. While denials can stem from various issues, a large majority are rooted in documentation errors, particularly those related to demonstrating medical necessity. Defining Medical Necessity: The American Medical Association (AMA) defines medical necessity as healthcare services or products provided to a […]
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RCM automation

Maximizing A/R Efficiency with RCM Automation

A well-managed A/R process ensures timely cash flow, reduces administrative burdens, and maintains the stability of a healthcare practice. However, many healthcare practices still struggle with outdated, manual A/R management processes that can lead to inefficiencies, errors, and delayed payments. In recent years, Revenue Cycle Management (RCM) automation has emerged as a game-changer in addressing […]
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Denial Management Process

3 Proactive Strategies for Improving Denial Management

In the ever-evolving field of medical billing, denied claims remain a significant obstacle for healthcare providers. Studies reveal that over 10% of claims face initial rejection by insurers, leading to revenue losses, administrative strain, and frustration for all stakeholders. To mitigate these challenges and ensure financial stability, an effective denial management process is essential. However, […]
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AI in Revenue Cycle Management

How AI is Revolutionizing Revenue Cycle Management

However, AI in Revenue Cycle Management is emerging as a transformative solution. By automating repetitive tasks, improving accuracy, and providing actionable insights, AI is helping healthcare organizations streamline their processes and tackle these challenges more effectively. Revenue Cycle Management (RCM) is a cornerstone of healthcare operations, yet the growing complexity of today’s healthcare landscape poses […]
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claim denials with chiropractic

Preventing Denied E&M Claims with Chiropractic Manipulative Therapy (CMT)

The observed an increasing number of denied Evaluation and Management (E&M) claims (99201-99215) when billed concurrently with chiropractic manipulation procedures, including chiropractic manipulative therapy (CMT), highlighting the potential for increased claim denials with Chiropractic Manipulative Therapy (CMT). Denial Reasons & Misconceptions: Common denial reasons include: “Service billed is included in another procedure billed the same […]
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Healthcare RCM with AI

Transforming Revenue Cycle Management: AI’s Role in Healthcare Success

As healthcare providers move into 2025, a technological revolution is reshaping revenue cycle management (RCM). Healthcare RCM with AI has emerged as a decisive factor in determining financial success or failure. With nearly 46% of hospitals and health systems already leveraging AI in their RCM operations, the industry faces a pivotal moment where keeping pace […]
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End-to-End Revenue Cycle Management: A Comprehensive Guide

End-to-End Revenue Cycle Management: A Comprehensive Guide

End to end RCM (Revenue Cycle Management) encompasses every step in the healthcare payment process, from patient registration to final reimbursement. By adopting a comprehensive RCM approach, healthcare organizations can improve cash flow, minimize errors, and ensure compliance with ever-changing regulations. This blog will explore the components, benefits, and best practices for implementing an end […]
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