The early eruption of the coronavirus prompted the federal government to urge a widespread halt of elective procedures in hopes of slowing the viral spread. For radiologists, this caused a massive decline in routine exams, which can result in a 40 percent-to-60 percent loss in revenue. Evolving health policies and industry environments keep revenue cycle […]
Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before delivering specific services or items for a patient. Payers are increasingly using prior authorizations to lower their costs and improve care […]
The clock is ticking, and you’re trying to select the right E/M level from a drop-down menu in the EHR. Choose a level that’s too high, and you run the risk of post-payment audits and recoupments. Choose one that’s too low, and you may lose revenue to which you’re entitled. You decide to just trust […]
The healthcare industry is unlike any other. In other businesses, you provide a product or service and the customer puts cash in your hand (more or less). However, the healthcare industry is very different. With multiple providers, claims to manage and reimbursements to deal with, getting money in the door in a timely manner can […]
New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
Hospital billing departments coordinate health plan benefits every day. Typically, coordination of benefits (COB) is aided by patient registration workflows that gather basic demographic and health insurance information. But what if a patient gets hurt on the job or in an automobile accident? How well does your organization collect the information needed to coordinate […]
The American Medical Association issued a checklist for the transition to fundamental changes in evaluation and management (E/M) services, a medical coding process in support of medical billing which practicing healthcare providers must use to be reimbursed by Medicare, Medicaid programs or private insurance. The checklist provides a guide for physician practices, which already are […]
In addition to patient billing and policy, healthcare M&A and workforce diversity will also be major trends going into the new year, according to PwC’s Health Research Institute. Patient billing, policy and regulation, healthcare mergers and acquisitions, and workforce diversity will be some of the top priorities for provider organizations in 2020, predicted researchers at PwC’s Health […]
Resolving credit balances can bring your organization out of the red and into the green. 6-Step Checklist to Recover Revenue Adjustments are correct Patient cost-sharing amounts are correct No duplicate payment postings Payments went to correct payers No charge entry errors Corrected claims are accounted for You may have encountered this situation: Your boss assigns […]
The right revenue cycle management technology can create a transparent, seamless patient experience, which benefits the bottom line. For the longest time, revenue cycle management has been the man behind the curtain. Healthcare organizations have focused on improving the clinical experience using technology and provider education while telling patients and providers to pay no attention […]