Tag: Outsourcing

Electronic Claims Management

Electronic Claims Management: Overcoming ERA and PA Challenges

The U.S. healthcare industry continues its digital transformation, with providers and payers embracing electronic transactions to streamline revenue cycle management (RCM) processes. According to the CAQH Index, adoption of electronic claims management transactions—such as eligibility verification, claim submissions, and claim status inquiries—has reached or surpassed 80% for many transaction types. However, significant gaps remain in […]
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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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ICD-10 Medical Billing Outsourcing: A Strategic Solution for Healthcare Providers

ICD-10 Medical Billing Outsourcing: A Strategic Solution for Healthcare Providers

The healthcare industry is in a perpetual state of change. A significant milestone occurred when the United States mandated the use of ICD-10 billing codes. This shift transformed billing procedures for medical providers, from solo physician practices to large hospitals. As a result, ICD10 medical billing outsourcing has become a critical solution for managing the […]
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Streamline Billing and Boost Revenue with Efficient Payment Posting

Streamline Billing and Boost Revenue with Efficient Payment Posting

While revenue cycle management (RCM) involves many steps, payment posting processes often gets overlooked. Optimizing this process acts as the cornerstone for smoother billing, reducing administrative burdens, and uncovering new revenue streams. By providing a clear view of daily income, accurate payment posting helps practices proactively address errors that could otherwise complicate medical billing and […]
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Navigating Outsourcing Vs Offshoring in Medical Billing: Explained

Navigating Outsourcing Vs Offshoring in Medical Billing: Explained

Outsourcing Vs Offshoring in Medical Billing: Targeting Cost Savings with a Global Reach: Both medical billing outsourcing and offshoring involve delegating billing tasks to another entity, but there’s a key difference in their destination: Medical Billing Outsourcing: In general outsourcing, the Medical Billing company can be located anywhere. It could be in the same state, […]
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Stop Authorization Denials in Tracks

Stop Authorization Denials in Tracks

Getting bogged down by authorization denials? You’re not alone. Here, we explore common roadblocks and effective strategies to keep your revenue flowing smoothly. Challenge: Drowning in Last-Minute Authorizations Solution: Divide and Conquer with a Multi-Team Approach Separate teams can tackle present and future authorizations. The “Today” team verifies benefits and identifies authorization needs for upcoming […]
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Study States, Providers Look to Outsource Revenue Cycle Management Services

Study States, Providers Look to Outsource Revenue Cycle Management Services

Healthcare Providers Turn to Outsourcing for Revenue Cycle Management Amid Workforce Shortages In an effort to enhance cash flow and improve patient care, healthcare providers are increasingly seeking reliable vendors to outsource their Revenue Cycle Management (RCM) services. A study reveals that many providers are outsourcing RCM processes to address staffing shortages and financial challenges. […]
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How AI Reshaping Hospital Revenue Cycle

How Artificial Intelligence, Analytics & Automation are Reshaping Hospital Revenue Cycle

The accelerating challenge around patient needs’ calls for new technology and automation, but on a personal level. As hospitals turn to technology to overhaul the patient experience and improve profits, a range of vendors are bringing new products and outsourced services to meet that demand with artificial intelligence, data analytics and natural language processing as […]
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New Rules Issued for Modifiers 59, XE, XS, XP, and XU

New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
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