Category: Revenue Cycle Management

outpatient claim denials

Close the Loopholes on Outpatient Claim Denials

Proactive measures in claim denial management can recoup lost revenue. Unfortunately, the majority of healthcare organizations encounter claim denials on a regular basis, often, habitually. Though claim denials may be an unavoidable reality in the world of healthcare, ineffective claim denials management can result in even more lost revenue. A 5 to 10 percent denial […]
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AI Can Help Health Plans

How AI Can Help Health Plans Become Member-Centric

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating). With so […]
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Medicare Claim Denials

Prevent Medicare Claim Denials in 2020

Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Social Security Number or their new MBI on claims. Starting Jan. 1, 2020, CMS will reject any Medicare claim Denials […]
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J Codes simplify Reimbursement

J Code Activations Simplify Billing Reimbursements For Practices

Several CMS-designated permanent and product-specific J-codes recently went into effect, allowing three ophthalmology-minded pharmaceutical companies to expand reimbursement through commercial and Medicare insurance plans. J-codes were activated Oct. 1 for FDA-approved products manufactured by EyePoint Pharmaceuticals, Ocular Therapeutix and Omeros. In the past, J-codes were announced once a year; now, CMS is issuing certain J-codes […]
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AR Management

How To Manage Accounts Receivable

Sound accounts receivable (A/R) management is integral to the financial health of a medical practice. The ability to maximize collections and profitability depends on it. Thus, it’s important that practices know what processes they can implement to ensure a smooth-running AR operation. David Norris, MD, MBA, an anesthesiologist in Wichita, Kan. and author of The […]
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Revenue CYcle Success

3 Issues Revenue Cycle Leaders Will Have To Battle In 2020

First hand experiences from the country’s most innovative revenue cycles will be shared next month in West Palm Beach, Florida. What issues keep revenue cycle executives up at night? As the HealthLeaders’ revenue cycle editor, I will moderate discussions and hear firsthand experiences of successes, challenges, and the latest ideas coming out of the country’s most innovative […]
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Revenue Cycle Technology

Automating Revenue Cycle Management Improves Patient Experience

The right revenue cycle management technology can create a transparent, seamless patient experience, which benefits the bottom line. For the longest time, revenue cycle management has been the man behind the curtain. Healthcare organizations have focused on improving the clinical experience using technology and provider education while telling patients and providers to pay no attention […]
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Patient Billing Disputes

How Hospitals Avoid or Reduce Patient Billing Disputes

CMS’ reworked the Merit-based Incentive Payment System, to simplify reporting requirements for providers in its 2020 Physician Fee Schedule Quality Payment Program Final Rule.Patient billing disputes result in more work for hospital staff and can potentially stand in the way of timely payment for services. However, many organizations are making efforts to avoid or reduce […]
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EM Code

Final Physician Payment Rule Keeps E/M Code Changes

CMS on Friday issued its 2020 final rules for the Physician Fee Schedule, including a streamlining of evaluation and management services (E/M) reporting that was rolled back from an earlier proposal in a change providers applauded. The final rule, which is mostly unchanged from the proposed rule put forward in July, also cuts payments to physical therapists […]
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