The Need for a Long-Term Solution to the Perennial SGR Problem

The decade old uncertainty over fixing a permanent solution to Sustainable Growth Rate (SGR) is set to continue with the House deciding not to set off the accumulated deficit (25% for 2011) against primary care physicians till the end of this year. Although a temporary relief for doctors, the absence of a permanent solution will […]

Read More.. The Need for a Long-Term Solution to the Perennial SGR Problem

Towards Realizing Medical Data Integration Nationally

The benefits of Integrating Medical Data nationally can be far-reaching. Given its multi-applicability, Macro-level Medical Integration Of Data can enable enhanced medical service and cost-efficiency, privacy compliance as per HIPAA, transparent billing and coding as per CPT, ICD-9, & HCPCS procedures, ready availability of health data for numerous references and verifications, advanced clinical research with […]

Read More.. Towards Realizing Medical Data Integration Nationally

Redefining the Role of Billers and Coders in the Wake of Ensuing Accountable Care Organization (ACO) Act

Amongst the many farsighted health reforms that the Patient Protection and Affordable Care Act of 2010 (PPACA) has floated is the concept of Accountable Care Organization (ACO). Believed to be a cost-controlling measure on public health expenditure, ACO is a health care model that ensures healthcare providers incentives from the savings made on a pre-assigned […]

Read More.. Redefining the Role of Billers and Coders in the Wake of Ensuing Accountable Care Organization (ACO) Act

Negotiating Payer Contracts for Physicians

The importance of negotiating or renegotiating payer contracts has drastically grown after the recent health care reforms. This is because insurance companies are being reined in by the government and may see a decline in profits. This presents a good opportunity for payer contracts to become a source of income more for the insurance companies […]

Read More.. Negotiating Payer Contracts for Physicians

Five Ways to Better Denial Management for Physicians

Denial management is one of the crucial aspects for a physician and can assist in improving the revenue cycle management. This can not only reduce errors while managing claim denials but also help in increasing the physician’s revenue. This process is carried out by medical billers and coders who have specialized knowledge in the field […]

Read More.. Five Ways to Better Denial Management for Physicians

Practice management Software – Benefits for physicians

Practice Management Software (PMS) can be a powerful tool for physicians since it can optimize administrative and financial activities in order to directly increase revenue and save time. A flexible and efficient PMS allows billers and coders to view Remittance Advice Reports and Claim Payment Reports in addition to interpreting Electronic Remittance Advice from the […]

Read More.. Practice management Software – Benefits for physicians

Payment Posting – Key to revenue cycle management

Payment posting is one of the most important steps that can assist in improving a physician’s revenue if done efficiently. Although payment posting is becoming electronic and automated there is still the need for checking for accuracy and errors in the posting. There are numerous ways in which physicians can benefit from accurate and efficient […]

Read More.. Payment Posting – Key to revenue cycle management

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 […]

Read More.. The Changing Face of Denial Management

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 […]

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

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 […]

Read More.. Increased inaccuracy in claims payments by health insurers