Denial Management in Healthcare: Optimizing Revenue through Effective Strategies

In the complex landscape of healthcare, denial management plays a pivotal role in ensuring financial stability for healthcare providers. Denial management refers to the systematic process of identifying, analyzing, and resolving denied or rejected claims from insurance payers. Effective denial management programs not only help healthcare organizations recover revenue but also streamline operational efficiency, reduce […]

Benefits of Outsourcing Accounts Receivable in Medical Billing

Accounts Receivable in Medical Billing Accounts Receivable in medical billing is retrieving of payments due by the insurance and patients to the physician for the delivered services. For the long-term financial sustainability of your practice, it’s crucial to keep accounts receivable under check. Accounts receivable are categorized as the number of days the payment hasn’t been […]

7 Ways to Reduce Revenue Leakage in Medical Billing

Revenue Leakage in Medical Billing ‘Revenue leakage’ refers to situations where a healthcare provider doesn’t receive insurance reimbursement for delivered services. In such billing situations, accounts receivable remain unpaid for too long and eliminate the chances of payment recovery, even partially. Healthcare practices cannot afford to ignore their revenue leakage as it’s directly affecting their […]

Avoiding Prior Authorization Denials

The burden of Prior Authorization According to a recent survey from the American Medical Association (AMA), prior authorization creates an administrative burden for healthcare practices, negatively impacting providers and delaying patient care. The survey also found that providers complete an average of 41 prior authorizations each week and spend an average of two business days […]

Making a Stronger RCM Team in 2022

A recent survey of U.S. healthcare organizations highlighted declining reimbursements as a top industry challenge. The COVID-19 pandemic changed payer billing guidelines, and reimbursement policies made receiving accurate reimbursement tougher. Reimbursement complications often lead to documentation and coding inaccuracies leading to increased claim denials. The healthcare reimbursement process requires complicated steps and, at each turn, […]

Improving Bottom Line of Your RCM

Revenue Cycle Management (RCM) is defined as the process of handling claims, processing payment, and generating revenue for your practice. It includes all functions associated with different steps of medical billing, beginning from the time when a patient makes an appointment and ending after all the claims and payments have been collected and the balance […]

Role of Medical Billers and Coders in RCM

Medical billing and coding translate a patient encounter into the form healthcare facilities use for claims submission and reimbursement. Medical billing and coding are separate processes, but both are necessary for providers to receive reimbursement for healthcare services. Medical Billers and Coders play a crucial role in revenue cycle management as their work starts from […]

RCM Strategies to Improve Practice Revenue

Your medical practice revenue is driven, impacted, and influenced by Revenue Cycle Management (RCM) strategies. It includes claims management, patient payments, and your in-house billing workflow. Without implementing these strategies, providers might find it difficult to maintain high levels of clean claims, adjust to an increasing dependence on patient payments, or manage their billing effectively. […]

What is MPFS (Medicare Physician Fee Schedule)?

Basics of Medicare Physician Fee Schedule As the name suggests Medicare Physician Fee Schedule (MPFS) is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. Medicare Part B pays for physician […]

Effective RCM Strategies to Collect Maximum Patient Responsibility

Patients’ financial responsibility is on the rise as more patients are choosing high-deductible health plans (HDHP). Increasing patient responsibility is an ongoing trend that does not seem to be slowing down in the near future. Providers report many challenges with responding to growing patient financial responsibility. Given the increased payment responsibility, being able to determine […]