The Changing Face of Denial Management

Denial management is one of the aspects that affect physicians, health care providers, insurance providers, and patients alike. The major problems faced by billers and coders along with patients are that the insurance companies or payers deny claims based on any reason they can find. This includes technicalities and some aspects such as pre-existing conditions […]


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Fraud and Abuse: A major reason for waste in the US Healthcare Spending

Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs. According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion […]


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Increased inaccuracy in claims payments by health insurers

Commercial health insurance has registered an increase of 2% over the existing average claims processing error rate of 19.3%. This 2% translates to an extra 3.6 million in erroneous claim payments, and costs an additional estimated $1.5 billion in highly avoidable administrative costs to the health system. AMA (American Medical Association) has released its Fourth […]


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Varying trends in physicians’ income in 2010

2010 registered a positive trend in terms of increased income for primary care physicians in the US. The increase in income varies according to the specialties i.e. some specialties saw a modest increase in income while others saw a more pertinent rise. The factors which are responsible for these changes in the income vary from […]


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Upgrading to HIPAA Version 5010

Adhering to the HIPAA 4010 compliance has been a long-standing ordeal for medical billing and coding professionals and now, on January 1, 2012, the electronic healthcare transactions standards change from version 4010/4010A to version 5010 will definitely need a closer look at the compliance guidelines. The healthcare industry and professionals need to thoroughly acquaint themselves […]


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Rural Healthcare Becoming a Lucrative Business

Recently, Texas has lifted a ban on prohibiting rural hospitals from employing physicians in order to solve the problem of shortages of doctors and health care providers in states such as Texas and California. However, it remains to be seen whether the recent healthcare reform would have some positive impact on the remuneration of physicians […]


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