Tag: Healthcare Compliance

Automated Insurance Eligibility Checks

Automated Insurance Eligibility Checks: Improving AR Days

Table of Contents Understanding the Impact of Denials and AR Days The Role of Automated Insurance Eligibility Checks Benefits of Automated Insurance Eligibility Checks Implementing Automated Insurance Eligibility Checks Insurance Eligibility Verification Service: A Critical Step for Healthcare Practices One significant challenge that healthcare providers face is the high rate of insurance claim denials and […]
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Historical Medical code set

Mastering Historical Medical Code Sets for Audits, Appeals, and Research

Remaining up-to-date is essential in the healthcare industry, but relying solely on current codes isn’t always the best approach. When auditing, handling appeals, or researching code usage for past encounters, a solid grasp of the descriptors and guidelines applicable during the date of service (DOS) can profoundly impact outcomes. Here’s a concise guide on effectively […]
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ICD-10-CM code updates

ICD-10-CM Updates: What You Need to Know

The accuracy of medical coding in the ever-evolving healthcare industry is not only crucial for accurate billing, but it is also crucial for quality reporting, compliance, and patient outcomes. The ICD-10-CM codes for 2024 have been updated, resulting in new and revised codes for healthcare providers that have an impact on multiple aspects of patient […]
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Debridement Coding

Optimizing Debridement Coding: Tips for Accurate Claims and Payments

The growing U.S. wound care market, fueled by an aging population and rising rates of chronic conditions, presents significant opportunities for healthcare providers. Accurate debridement coding is essential to maximize reimbursement and optimize patient care. Pressure injuries alone affect around 2.5 million Americans each year, leading to more than 60,000 deaths and costing between $9.1 […]
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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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Benefits of Outsourcing rcm

The benefits of outsourcing RCM functions

Healthcare providers face a daunting task in managing the complexity of revenue cycle management (RCM) in today’s healthcare environment. One of the key benefits of outsourcing RCM is that it can significantly reduce these administrative burdens. The administrative burdens faced by healthcare organizations often rise as regulations, reimbursement models, and patient expectations change. As a […]
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ICD-10 to ICD-11

ICD-10 to ICD-11: Bridging the Gap with Best Practices

The Evolution of Medical Coding (ICD-10 to ICD-11) As we transition from ICD-10 to ICD-11, it’s crucial to understand the implications of these changes on data accuracy, clinical documentation, and overall healthcare management. Healthcare data are based on medical coding, which plays a vital role in categorizing diseases, health conditions, and medical procedures. It has […]
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Cyberattack on Change Healthcare: HIPAA Breach Notification

Following a major cyberattack on Change Healthcare, a subsidiary of UnitedHealth Group (UHG), confusion arose regarding who would handle the Change Healthcare cyberattack HIPAA breach notification for potentially millions of affected individuals. HIPAA regulations govern such notifications, but the situation presented unique challenges. In May 2024, the Department of Health and Human Services (HHS) issued […]
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ICD-10 Coding Challenges

Demystifying the Most Common ICD-10 Coding Challenges

Medical coding is the backbone of administrative and clinical processes in healthcare. This landscape is characterized by the International Classification of Diseases, 10th Edition (ICD-10), which provides a standardized system to classify diseases, injuries, and medical procedures. While ICD-10 offers robust benefits in terms of specificity and data granularity, healthcare professional’s worldwide face significant challenges […]
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Radiology RCM Strategies

Radiology RCM Strategies for Success in a Changing Landscape

The field of medical Specialties, with its cutting-edge technology and intricate procedures, presents a unique environment for radiology RCM. While it offers the potential for significant success, navigating the RCM landscape in radiology requires a keen understanding of the industry’s specific challenges. This includes navigating the complexities of billing and coding, keeping pace with evolving […]
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