Tag: Us Healthcare News

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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How Cryptocurrency is Revolutionizing Medical Billing with Technology

How Cryptocurrency is Revolutionizing Medical Billing with Technology

Cryptocurrency benefits medical billing by revolutionizing the industry. It offers a decentralized digital currency that serves as a medium of exchange, similar to traditional money. This innovative approach facilitates secure digital transactions, making counterfeiting nearly impossible due to the robust cryptography employed.  Another key advantage is that cryptocurrency operates outside government authority, eliminating taxes or […]
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Automated Insurance Eligibility Checks: Improving AR Days

Automated Insurance Eligibility Checks: Improving AR Days

Table of Contents Understanding the Impact of Denials and AR Days The Role of Automated Insurance Eligibility Checks Benefits of Automated Insurance Eligibility Checks Implementing Automated Insurance Eligibility Checks Insurance Eligibility Verification Service: A Critical Step for Healthcare Practices One significant challenge that healthcare providers face is the high rate of insurance claim denials and […]
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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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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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Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage Plans and the Two-Midnight Rule

Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting comments and questions. I can’t […]
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“Defensive” Undercoding Is Indefensible

“Defensive” Undercoding Is Indefensible

Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider Reimbursement […]
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3 Key Strategies to Increase Healthcare Revenue Cycle Efficiency

3 Key Strategies to Increase Healthcare Revenue Cycle Efficiency

As providers engage in complex payment models and collect more from patients, they must learn to automate key functions to improve healthcare revenue efficiency. The healthcare revenue cycle has many moving parts. From patient access and registration to medical billing and coding, provider organizations of all sizes must achieve revenue cycle efficiency to ensure providers […]
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Preparing Providers For Value-Based Care

Preparing Providers For Value-Based Care, Consumerism In Healthcare

Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Transforming raw data into actionable information is crucial to the financial future of provider organizations, especially as pressure builds on providers to align their care delivery approach with value-based care and consumerism in healthcare. […]
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