Prior authorization transformation of consent is a source of worry and concern for everyone involved: patients, members, providers, and payers. What was needed was a structure to coordinate all stakeholders and organize the program. In January 2024, the Centers for Medicare and Medicaid Services (CMS) finalized requirements to expedite the authorization process; this requirement will […]
It is imperative that medical billing be as efficient as possible in today’s fast-paced healthcare environment in order to achieve financial stability and maintain a thriving practice. We must admit, however, that monotonous tasks and constant change can quickly lead to burnout. The purpose of this newsletter is to provide you with five key strategies […]
Claims Denial: Healthcare Leaders report an increase in payer denials, putting increasing pressure on the system’s finances. Going back and forth with denied payers is a long and expensive process, and low reimbursement rates don’t help either. In a new survey conducted by the Healthcare Financial Management Association, CFOs noted a significant increase in denials, […]
Outsource RCM: Providers who spend too much on RCM staff and processes, or who experience a high rate of claims denials, should consider outsourcing their medical billing requirements. While our experts chase down payments, you can provide the care, receive the funds, and improve your key performance indicators. Outsource RCM makes sense Why Healthcare Providers […]
The front desk staff is responsible for checking in patients, collecting copies, and verifying insurance coverage on behalf of the patients. Out of sight does not mean out of mind, and out of sight does not mean out of mind when it comes to the underlying issues. Medical billing companies rely heavily on their support […]
Interoperability role in medical billing: A growing number of physicians practice in an interconnected world, which means that medical practices and hospitals need to seamlessly share information in order to be able to provide good health management and ensure that patients are treated safely and effectively. Health care interoperability is an important concept that has […]
Medical Billing Myths: Medical billing is an important part of the complicated world of healthcare management. However, many practice owners struggle to negotiate the complexities of medical billing. Myths and misconceptions about medical billing can exacerbate problems, resulting in financial losses and administrative headaches. To help keep you educated and empowered, we’ve developed a list […]
Secure Medical Billing Practices: In the ever-evolving healthcare landscape, protecting patient privacy and safeguarding sensitive medical information remains paramount. The Health Insurance Portability and Accountability Act (HIPAA) serves as the cornerstone of these efforts, dictating robust data security standards for covered entities handling protected health information (PHI). As we navigate 2024, staying updated on HIPAA […]
MA rates face a potential 0.2% reduction as proposed by CMS. However, analysts said regulators are likely to increase the payout rate in the final announcement. Medicare Advantage health insurers will see a slight decline in their payment MA Rates in 2025 as a new regulatory proposal is finalized. CMS released interim reimbursement rates for […]
2024 MPFS Final Rule: If you don’t have time to read the final medical fee schedule rule, be sure to read this section. Medicare policies may have a significant impact on all payer policies. Therefore, it is important for anyone working with health insurance claims to be aware of policy changes in the New Year. […]