Tag: Healthcare Revenue Cycle

Reduce AR Days

Reduce AR Days and Improve Reimbursements with Cash Flow Cure

Accounts Receivable (AR) days directly impact cash flow and overall financial health. The longer a claim sits in AR, the more challenging it becomes to collect revenue, leading to cash flow disruptions, operational inefficiencies, and reduced profitability. Therefore, it’s crucial for businesses to actively work to reduce AR days and improve their financial performance. With […]
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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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telehealth billing strategies

Telehealth Billing Strategies: Maximizing Revenue

Telehealth revenue can be a lifeline for many healthcare organizations struggling financially due to cancellations of elective and non-urgent procedures. However, maximizing this revenue stream requires effective Telehealth Billing Strategies. This includes accurate coding, timely claim submissions, and navigating the complexities of payer reimbursement policies for virtual services. Understanding Telehealth Billing: A Few Key Concepts […]
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Medical Coding Denials

Top Strategies to Prevent Medical Coding Denials

Medical coding denials are a common challenge for healthcare providers and revenue cycle management (RCM) teams. They can disrupt cash flow, delay reimbursements, and increase administrative workloads. Avoiding these denials requires a proactive approach that addresses their root causes, ensures compliance with regulations, and fosters a culture of continuous improvement. In this blog, we’ll explore […]
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Insurance Claim Denials

Navigating Insurance Claim Denials: A Step-by-Step Guide

Imagine receiving an Insurance Claim Denials notice that states services are not covered or require prior authorization. Table of Contents Requires Prior Authorization Coverage Terminated or Member Not Eligible on the Date of Service Services Performed are Non-Covered Maximum Benefit for This Service Has Been Met Steps for Obtaining Authorization The Importance of Verification and […]
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Charge Capture in Healthcare

Charge Capture: A Critical Step in Revenue Cycle Management

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 […]
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Optimizing RCM

Optimize Revenue Cycle Management: Strategies for Value-Based Care

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, […]
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claim denial management

Claim Denial Management: A Comprehensive Guide

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 […]
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Front-End Revenue Cycle Management

The Importance of Front-End Revenue Cycle Management in Healthcare

The success of a healthcare provider’s financial performance hinges heavily on the efficiency of its front-end revenue cycle management. While the mid and back-end processes, such as coding, billing, and denials management, often receive significant attention, it’s crucial to recognize the profound impact of pre-encounter activities on overall revenue cycle efficiency. Front-end revenue cycle encompasses […]
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Denial prevention

Denial Prevention: A Strategic Imperative for Revenue Cycle Management

Denial prevention has become a paramount focus within healthcare revenue cycles, as the financial toll of claim denials continues to rise. The increasing use of artificial intelligence (AI) by payers has further exacerbated this challenge. To mitigate these losses, a strategic shift is necessary, transitioning from a reactive approach of managing denials post-occurrence to a […]
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