Tag: Healthcare Revenue Cycle

Medical coding and billing challenges

Overcoming Medical Coding & Billing Challenges | Allzone

Medical coding and billing are critical components of the healthcare revenue cycle. They ensure that healthcare providers receive proper reimbursement for the services rendered. However, the ever-evolving regulatory landscape, shifting payer policies, and technological advancements present numerous Medical Coding & Billing Challenges. These challenges significantly impact the efficiency and accuracy of the revenue cycle. As […]
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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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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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